Provider Demographics
NPI:1427742840
Name:MORMANT, PHAION D
Entity type:Individual
Prefix:
First Name:PHAION
Middle Name:D
Last Name:MORMANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SUN VALLEY DR STE D2
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5636
Mailing Address - Country:US
Mailing Address - Phone:770-910-9162
Mailing Address - Fax:
Practice Address - Street 1:500 SUN VALLEY DR STE D2
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5636
Practice Address - Country:US
Practice Address - Phone:770-910-9162
Practice Address - Fax:770-910-9768
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty