Healthcare Provider Details

I. General information

NPI: 1194994210
Provider Name (Legal Business Name): TROY MAC PHILLIPS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 S ALLEN RD STE 63
FLAT ROCK NC
28731-9447
US

IV. Provider business mailing address

571 S ALLEN RD STE 63
FLAT ROCK NC
28731-9447
US

V. Phone/Fax

Practice location:
  • Phone: 828-513-2676
  • Fax: 877-275-5923
Mailing address:
  • Phone: 828-513-2676
  • Fax: 877-275-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number1618
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1618
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL1618
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1618
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-48528
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: