Healthcare Provider Details

I. General information

NPI: 1851842652
Provider Name (Legal Business Name): PHILIP GAROFANO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 S MARIETTA PKWY SE
MARIETTA GA
30067-4440
US

IV. Provider business mailing address

8901 STONEBRIDGE BLVD STE 100
DOUGLASVILLE GA
30134-2210
US

V. Phone/Fax

Practice location:
  • Phone: 678-878-2950
  • Fax:
Mailing address:
  • Phone: 678-838-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN220604
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN220604
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN220604
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: