Healthcare Provider Details

I. General information

NPI: 1306108865
Provider Name (Legal Business Name): W JONES PHILLIPS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 MEDICAL PARK LN
GAINESVILLE GA
30501-2084
US

IV. Provider business mailing address

698 MEDICAL PARK LN
GAINESVILLE GA
30501-2084
US

V. Phone/Fax

Practice location:
  • Phone: 770-718-1090
  • Fax: 770-718-0198
Mailing address:
  • Phone: 770-718-1090
  • Fax: 770-718-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN009961
License Number StateGA

VIII. Authorized Official

Name: DR. WILLIAM JONES PHILLIPS
Title or Position: DENTIST
Credential: DDS
Phone: 770-718-1090