# GEORGIA PHS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073872487
- **Authorized official:** NICOLE HOWARD (CFO)
- **Authorized official phone:** (337) 991-9276

## Contact information

- **Practice address:** 3355 LENOX RD NE, SUITE 750, ATLANTA, GA 30326-1394
- **Practice address phone:** (877) 260-4747
- **Practice address fax:** (901) 261-4867
- **Mailing address:** 1509 DULLES DRIVE, LAFAYETTE, LA 70506
- **Mailing address phone:** (337) 991-9276
- **Mailing address fax:** (337) 991-9288

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/07/2012
- **Last updated:** 11/20/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003125161A | — | GA |