Provider Demographics
NPI:1700664489
Name:PHINIZY, MILLICENT (MS, EDS)
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:
Last Name:PHINIZY
Suffix:
Gender:F
Credentials:MS, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5868 COBBLESTONE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2609
Mailing Address - Country:US
Mailing Address - Phone:678-547-6212
Mailing Address - Fax:
Practice Address - Street 1:5868 COBBLESTONE CREEK CIR
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-2609
Practice Address - Country:US
Practice Address - Phone:678-547-6212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program