Healthcare Provider Details

I. General information

NPI: 1245215797
Provider Name (Legal Business Name): PHILLIPS MEDICAL EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 MONTICELLO ST SW
COVINGTON GA
30014-2329
US

IV. Provider business mailing address

1174 MONTICELLO ST SW
COVINGTON GA
30014-2329
US

V. Phone/Fax

Practice location:
  • Phone: 678-658-4663
  • Fax: 678-658-4664
Mailing address:
  • Phone: 678-658-4663
  • Fax: 678-658-4664

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 TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JEFF BRAUN
Title or Position: DIRECTOR
Credential:
Phone: 636-733-7200