Healthcare Provider Details

I. General information

NPI: 1285633263
Provider Name (Legal Business Name): ZACHARY KEITH PHILLIPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5018 CAHABA RIVER RD
VESTAVIA AL
35243-2317
US

IV. Provider business mailing address

PO BOX 370
FORTSON GA
31808-0370
US

V. Phone/Fax

Practice location:
  • Phone: 205-397-5200
  • Fax: 205-203-9858
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-301
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.301
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: