Healthcare Provider Details

I. General information

NPI: 1679734206
Provider Name (Legal Business Name): ERIC KINSEY PHILLIPS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 LENDEW ST
GREENSBORO NC
27408-7033
US

IV. Provider business mailing address

1915 LENDEW ST
GREENSBORO NC
27408-7033
US

V. Phone/Fax

Practice location:
  • Phone: 336-275-3325
  • Fax: 336-275-5346
Mailing address:
  • Phone: 336-275-3325
  • Fax: 336-275-5346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-02042
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0010-02042
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: