Provider Demographics
NPI:1316335078
Name:THRIVE COMMUNITY OUTREACH
Entity type:Organization
Organization Name:THRIVE COMMUNITY OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZZARI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:770-449-2151
Mailing Address - Street 1:230 S CULVER ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4806
Mailing Address - Country:US
Mailing Address - Phone:770-449-2151
Mailing Address - Fax:
Practice Address - Street 1:230 S CULVER ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4806
Practice Address - Country:US
Practice Address - Phone:770-449-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028884207RG0300X
GARN124271364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & FamilyGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty