Provider Demographics
NPI:1710537972
Name:DRAKE, PHILIP Y
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:Y
Last Name:DRAKE
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 1:155 POPLAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-2745
Mailing Address - Country:US
Mailing Address - Phone:770-378-2415
Mailing Address - Fax:
Practice Address - Street 1:5185 PEACHTREE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-2152
Practice Address - Country:US
Practice Address - Phone:770-734-0746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral