Provider Demographics
NPI:1164941415
Name:HUMPHREY, DARIUS TERRAY (NP)
Entity Type:Individual
Prefix:MR
First Name:DARIUS
Middle Name:TERRAY
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11633 SAN VICENTE BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6513
Mailing Address - Country:US
Mailing Address - Phone:310-979-8378
Mailing Address - Fax:310-979-8379
Practice Address - Street 1:3161 HOWELL MILL RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2135
Practice Address - Country:US
Practice Address - Phone:404-351-5812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007584363LF0000X
GARN318848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily