Healthcare Provider Details

I. General information

NPI: 1043764731
Provider Name (Legal Business Name): PHILLIP BOATRIGHT JR. PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 INDUSTRIAL BLVD
DUBLIN GA
31021-2904
US

IV. Provider business mailing address

460 MALL BLVD STE B
SAVANNAH GA
31406-4891
US

V. Phone/Fax

Practice location:
  • Phone: 800-827-6523
  • Fax: 126-445-2609
Mailing address:
  • Phone: 478-289-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8107
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: