Individual
MRS. PHYLLIS PELFREY COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN
Contact information
Practice address
3647 J DEWEY GRAY CIR STE 200, AUGUSTA, GA 30909-2205
(706) 504-9712
(706) 504-9703
Mailing address
PO BOX 3548, AUGUSTA, GA 30914-3548
(706) 863-9595
(706) 868-8375
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN158279
GA
363LF0000X
Family Nurse Practitioner
RN158279
GA
Other
Enumeration date
10/11/2013
Last updated
02/09/2022
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