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NPI Code Detail

MEDICARE: J. DARREN PHILLIPS AT

MEDICARE: J. DARREN PHILLIPS AT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer188AL

General Provider Information

NPI Number : 1205052891
Entity Type Code : Individual
Provider Name (Legal Business Name) : J. DARREN PHILLIPS AT
Provider Business Mailing Address
First Line : PO BOX 729
Second Line :
City : DOTHAN
State : AL
Zip : 36302-0729
Country : US
Telephone Number : 334-793-2663
Fax Number : 334-836-2247
Provider Business Practice Location Address
First Line : 404 N MAIN ST
Second Line :
City : ENTERPRISE
State : AL
Zip : 36330-2563
Country : US
Telephone Number : 334-308-9797
Fax Number : 334-836-2247
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 07/08/2007

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