Healthcare Provider Details

I. General information

NPI: 1538514617
Provider Name (Legal Business Name): CAROLINE CONLEY PHILLIPS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 TOWN CENTER BLVD
KNOXVILLE TN
37922-6638
US

IV. Provider business mailing address

1975 TOWN CENTER BLVD
KNOXVILLE TN
37922-6638
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-3998
  • Fax: 865-546-1123
Mailing address:
  • Phone: 865-546-3998
  • Fax: 865-546-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number4631
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: