Healthcare Provider Details

I. General information

NPI: 1215922216
Provider Name (Legal Business Name): PHILLIP A COY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 SKYLINE DR
JACKSON TN
38301-3903
US

IV. Provider business mailing address

PO BOX 400
JACKSON TN
38302-0400
US

V. Phone/Fax

Practice location:
  • Phone: 731-422-0213
  • Fax: 731-882-5052
Mailing address:
  • Phone: 731-423-8697
  • Fax: 731-423-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1216
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: