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General NPI Number Information
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NPI Number | 1295524973
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Entity Type | Organization
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Legal Business Name | PHOENIX & SYCOMORE ENTERPRISES, LLC
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 8735 DUNWOODY PL STE 8329
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City | ATLANTA
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State | GA
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Zip | 30350-2995
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Country | US
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Telephone | 770-742-9302
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Fax |
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Provider Business Mailing Address
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Address Line | 8735 DUNWOODY PL STE 8329
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City | ATLANTA
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State | GA
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Zip | 30350-2995
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Country | US
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Telephone | 770-742-9302
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. ZAYN GERAKITIS
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Credential | MD
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Telephone | 770-742-9302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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