Healthcare Provider Details

I. General information

NPI: 1407955537
Provider Name (Legal Business Name): JOSHUA F PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 LAKELAND DR., SUITE 101
JACKSON MS
39216
US

IV. Provider business mailing address

1513 LAKELAND DR. SUITE 101
JACKSON MS
39216
US

V. Phone/Fax

Practice location:
  • Phone: 601-354-4836
  • Fax: 601-354-2619
Mailing address:
  • Phone: 601-354-4836
  • Fax: 601-354-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number18672
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: