Healthcare Provider Details

I. General information

NPI: 1255240933
Provider Name (Legal Business Name): ERIC PHILLIPS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

5815 ARBOR ISLE WAY UNIT 310
MYRTLE BEACH SC
29577-8829
US

V. Phone/Fax

Practice location:
  • Phone: 843-692-1000
  • Fax:
Mailing address:
  • Phone: 731-499-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number274661
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: