Healthcare Provider Details

I. General information

NPI: 1528562022
Provider Name (Legal Business Name): PHILIP BORGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 LANIER AVE W STE 100
FAYETTEVILLE GA
30214-7659
US

IV. Provider business mailing address

874 LANIER AVE W STE 100
FAYETTEVILLE GA
30214-7659
US

V. Phone/Fax

Practice location:
  • Phone: 770-515-8204
  • Fax:
Mailing address:
  • Phone: 770-515-8204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number96859
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: