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Individual

PHYLLIS BIRT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
915 INTERSTATE RIDGE DR, SUITE G, GAINESVILLE, GA 30501-7076
(678) 513-5700
(678) 513-5836
Mailing address
4331 THURMOND TANNER RD, FLOWERY BRANCH, GA 30542-2829
(678) 513-5700
(678) 513-5836

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN031752
GA

Other

Enumeration date
08/11/2011
Last updated
08/11/2011
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