Healthcare Provider Details

I. General information

NPI: 1174312862
Provider Name (Legal Business Name): PHOENIX & SYCOMORE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL STE 8329
ATLANTA GA
30350-2995
US

IV. Provider business mailing address

8735 DUNWOODY PL STE 8329
ATLANTA GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 770-742-9302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ZAYN GERAKITIS
Title or Position: OWNER/OPERATOR
Credential: MD
Phone: 770-742-9302