Healthcare Provider Details

I. General information

NPI: 1417942319
Provider Name (Legal Business Name): TERRI PRATHER BYRD PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 LAWRENCEVILLE HWY NW
LILBURN GA
30047-2817
US

IV. Provider business mailing address

3003 LAKEVIEW PKWY
VILLA RICA GA
30180-7823
US

V. Phone/Fax

Practice location:
  • Phone: 770-935-0061
  • Fax: 770-935-0069
Mailing address:
  • Phone: 770-214-3738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH016442
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: