Healthcare Provider Details

I. General information

NPI: 1902937444
Provider Name (Legal Business Name): G PHILLIPS VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 7TH AVE
ALBANY GA
31701-1921
US

IV. Provider business mailing address

PO BOX 72148
ALBANY GA
31708-2148
US

V. Phone/Fax

Practice location:
  • Phone: 229-432-1203
  • Fax: 229-432-1676
Mailing address:
  • Phone: 229-432-1203
  • Fax: 229-432-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009131
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GARY PHILLIPS
Title or Position: PRESIDENT
Credential:
Phone: 229-432-1203