Healthcare Provider Details

I. General information

NPI: 1982676664
Provider Name (Legal Business Name): JUSTIN WESLEY PHILLPOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 NORMANDIE DR 108
MONTGOMERY AL
36111-2732
US

IV. Provider business mailing address

2055 NORMANDIE DR 108
MONTGOMERY AL
36111-2732
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-4624
  • Fax: 334-280-3628
Mailing address:
  • Phone: 334-288-4624
  • Fax: 334-280-3628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number053805
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME76550
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME76550
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number00026333
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number00026333
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberJ8715
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number053805
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberJ8715
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: