Individual
DR. PHILLIP N BANNISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 OLD NORCROSS RD, SUITE B, LAWRENCEVILLE, GA 30045-4311
(770) 962-3006
(770) 962-9079
Mailing address
601 OLD NORCROSS RD, SUITE B, LAWRENCEVILLE, GA 30045-4311
(770) 962-3006
(770) 962-9079
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
016503
GA
Other
Enumeration date
01/05/2007
Last updated
07/08/2007
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