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General NPI Number Information
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NPI Number | 1255827770
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Entity Type | Individual
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Provider Name | KAITLYN PHILLIPS
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Gender | Female
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 2900 DELK RD SE STE 1150
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City | MARIETTA
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State | GA
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Zip | 30067-5320
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Country | US
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Telephone | 770-612-5155
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Fax |
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Provider Business Mailing Address
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Address Line | 900 BATTERY AVE SE UNIT 623
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City | ATLANTA
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State | GA
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Zip | 30339-2848
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Country | US
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Telephone | 706-977-8600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH030537
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License Number State | GA
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