Provider Demographics
NPI:1295825248
Name:ROLAND, PHYLLIS H (RN)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:H
Last Name:ROLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CEDAR ROCK MDWS
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6420 POLLARDS POND RD
Practice Address - Street 2:
Practice Address - City:APPLING
Practice Address - State:GA
Practice Address - Zip Code:30802-3726
Practice Address - Country:US
Practice Address - Phone:706-447-7679
Practice Address - Fax:706-868-3336
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN046458163WC1500X
CA568492163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice