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Organization
GEORGIA PHS PC
Active
Organization
GEORGIA PHS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HOWARD (CFO)
(337) 991-9276
Entity
Organization
Contact information
Practice address
3355 LENOX RD NE, SUITE 750, ATLANTA, GA 30326-1394
(877) 260-4747
(901) 261-4867
Mailing address
1509 DULLES DRIVE, LAFAYETTE, LA 70506
(337) 991-9276
(337) 991-9288
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003125161A
—
GA
Enumeration date
05/07/2012
Last updated
11/20/2014
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