MEDICARE: PHYLLIS GRIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1770350456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS GRIER

Provider Business Mailing Address
First Line	:	8204 PARK RIDGE DR
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4320
Country	:	US
Telephone Number	:	404-245-1092
Fax Number	:

Provider Business Practice Location Address
First Line	:	1335 LAKE RIDGE PKWY
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-3393
Country	:	US
Telephone Number	:	404-245-1092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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Directions to “ PHYLLIS GRIER ” Practice Location

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