Provider Demographics
NPI:1578293809
Name:PIERRE, PHILIPPE THOMAS (CLC)
Entity Type:Individual
Prefix:MR
First Name:PHILIPPE
Middle Name:THOMAS
Last Name:PIERRE
Suffix:
Gender:M
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 EDGEWATER CIR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3896
Mailing Address - Country:US
Mailing Address - Phone:917-426-2780
Mailing Address - Fax:
Practice Address - Street 1:3900 LEGACY PARK BLVD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7412
Practice Address - Country:US
Practice Address - Phone:404-482-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach