Provider Demographics
NPI:1972274488
Name:FURLOW, DARIASZ RAPHVIALE (CERTIFIED NURSE AIDE)
Entity Type:Individual
Prefix:
First Name:DARIASZ
Middle Name:RAPHVIALE
Last Name:FURLOW
Suffix:
Gender:F
Credentials:CERTIFIED NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1632
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30086-1632
Mailing Address - Country:US
Mailing Address - Phone:404-665-6926
Mailing Address - Fax:
Practice Address - Street 1:2330 SCENIC HWY S STE 636
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3115
Practice Address - Country:US
Practice Address - Phone:888-383-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030054284376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide