Healthcare Provider Details

I. General information

NPI: 1477833770
Provider Name (Legal Business Name): JANNA PHILLIPS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S FIRST AVE
MC RAE GA
31055-3334
US

IV. Provider business mailing address

160 S FIRST AVE
MC RAE HELENA GA
31055-3334
US

V. Phone/Fax

Practice location:
  • Phone: 731-394-1145
  • Fax:
Mailing address:
  • Phone: 229-868-6473
  • Fax: 229-868-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP133630
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: