Healthcare Provider Details

I. General information

NPI: 1083866974
Provider Name (Legal Business Name): BRAD CLINTON PHILLIPS D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 PIEDMONT AVE NE
ATLANTA GA
30324-5032
US

IV. Provider business mailing address

4525 SPRINGWOOD DR
MONROE GA
30655-8394
US

V. Phone/Fax

Practice location:
  • Phone: 404-875-7387
  • Fax:
Mailing address:
  • Phone: 770-266-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVET7103
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: