Healthcare Provider Details

I. General information

NPI: 1114926797
Provider Name (Legal Business Name): J WILLIAM PHILLIPS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAMES WILLIAM PHILLIPS III MD

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/21/2022
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 BERNARDIN AVE STE 220
COLUMBIA SC
29204-2044
US

IV. Provider business mailing address

PO BOX 935722
ATLANTA GA
31193-5722
US

V. Phone/Fax

Practice location:
  • Phone: 803-409-7170
  • Fax: 803-409-7175
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number23595
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number23595
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: