Provider Demographics
NPI:1124467113
Name:PHIRI, GEOFFREY (N/A)
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:
Last Name:PHIRI
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:GOEFFREY
Other - Middle Name:
Other - Last Name:PHIRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1980 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2016
Mailing Address - Country:US
Mailing Address - Phone:404-384-8777
Mailing Address - Fax:
Practice Address - Street 1:1980 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2016
Practice Address - Country:US
Practice Address - Phone:404-384-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOCC5299372500000X, 372600000X
GAOCC005299374T00000X, 374U00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide