Healthcare Provider Details

I. General information

NPI: 1164746236
Provider Name (Legal Business Name): LAURA RAGAN PHILLIPS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MEDICAL RIDGE DR
GREENVILLE SC
29605-4267
US

IV. Provider business mailing address

28 MEDICAL RIDGE DR
GREENVILLE SC
29605-4267
US

V. Phone/Fax

Practice location:
  • Phone: 864-271-7440
  • Fax: 864-271-6001
Mailing address:
  • Phone: 864-271-7440
  • Fax: 864-271-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5836
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1454
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: