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General NPI Number Information
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NPI Number | 1518820216
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Entity Type | Individual
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Provider Name | AERYN MACKENSI PHILLIPS
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Gender | Female
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 2295 TOWNE LAKE PKWY
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City | WOODSTOCK
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State | GA
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Zip | 30189-5520
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Country | US
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Telephone | 770-517-2088
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Fax |
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Provider Business Mailing Address
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Address Line | 3686 FALLS TRL
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City | WINSTON
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State | GA
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Zip | 30187-1593
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Country | US
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Telephone | 404-242-1480
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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 | RPH035955
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License Number State | GA
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