Healthcare Provider Details

I. General information

NPI: 1568375558
Provider Name (Legal Business Name): MACEY PAYTON PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 ATLANTA HWY
MONTGOMERY AL
36109-3323
US

IV. Provider business mailing address

904 POSSUM TROT RD
DEATSVILLE AL
36022-4603
US

V. Phone/Fax

Practice location:
  • Phone: 334-452-9947
  • Fax:
Mailing address:
  • Phone: 334-452-9947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: