Healthcare Provider Details

I. General information

NPI: 1750366266
Provider Name (Legal Business Name): PHILIP ANDREW HORTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOSPITAL ROAD DWIGHT D. EISENHOWER MEDICAL CENTER - 12F
FORT GORDON GA
30905-5650
US

IV. Provider business mailing address

300 HOSPITAL ROAD DWIGHT D. EISENHOWER MEDICAL CENTER - 12F
FORT GORDON GA
30905-5650
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-8290
  • Fax: 706-787-0105
Mailing address:
  • Phone: 706-432-3837
  • Fax: 706-432-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number034081
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: