Healthcare Provider Details

I. General information

NPI: 1881643443
Provider Name (Legal Business Name): PHILIP JAMES VILLIOTTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 YACHT CLUB LN
SAINT SIMONS ISLAND GA
31522-2311
US

IV. Provider business mailing address

406 YACHT CLUB LN
SAINT SIMONS ISLAND GA
31522-2311
US

V. Phone/Fax

Practice location:
  • Phone: 207-944-1440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number84661
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME15309
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: