Healthcare Provider Details

I. General information

NPI: 1114961000
Provider Name (Legal Business Name): THOMAS W PHILLIPS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E WOOD ST DEPT OF
SPARTANBURG SC
29303-3040
US

IV. Provider business mailing address

101 E WOOD ST DEPT OF
SPARTANBURG SC
29303-3040
US

V. Phone/Fax

Practice location:
  • Phone: 864-560-6000
  • Fax: 864-560-6276
Mailing address:
  • Phone: 864-560-6000
  • Fax: 864-560-6276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number057137
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD28395
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: