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General NPI Number Information
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NPI Number | 1073872487
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Entity Type | Organization
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Legal Business Name | GEORGIA PHS PC
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 3355 LENOX RD NE SUITE 750
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City | ATLANTA
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State | GA
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Zip | 30326-1394
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Country | US
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Telephone | 877-260-4747
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Fax | 901-261-4867
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Provider Business Mailing Address
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Address Line | 1509 DULLES DRIVE
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City | LAFAYETTE
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State | LA
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Zip | 70506
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Country | US
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Telephone | 337-991-9276
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Fax | 337-991-9288
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Authorized Official
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Title or Position | CFO
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Name | NICOLE HOWARD
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Credential |
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Telephone | 337-991-9276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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