Provider Demographics
NPI:1669252656
Name:PERKINS, PHILLIP ZACHARY (FNP)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ZACHARY
Last Name:PERKINS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 TRANSYLVANIA CT
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-7517
Mailing Address - Country:US
Mailing Address - Phone:478-299-6719
Mailing Address - Fax:
Practice Address - Street 1:1067 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434-1558
Practice Address - Country:US
Practice Address - Phone:478-625-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN282573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily