Healthcare Provider Details

I. General information

NPI: 1003399718
Provider Name (Legal Business Name): PHILLIP ZAFFOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 DALLAS HWY SW STE 240
MARIETTA GA
30064-2597
US

IV. Provider business mailing address

2655 DALLAS HWY SW STE 240
MARIETTA GA
30064-2597
US

V. Phone/Fax

Practice location:
  • Phone: 678-923-2885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007858
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: