Provider Demographics
NPI:1326726431
Name:PHIFER, ROSHAUNDRA C (NP)
Entity Type:Individual
Prefix:
First Name:ROSHAUNDRA
Middle Name:C
Last Name:PHIFER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:995 HUNTERHILL DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4214
Mailing Address - Country:US
Mailing Address - Phone:219-973-1246
Mailing Address - Fax:
Practice Address - Street 1:2810 PEACHTREE INDUSTRIAL BLVD STE D
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8142
Practice Address - Country:US
Practice Address - Phone:404-381-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195744363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty