Healthcare Provider Details

I. General information

NPI: 1154648426
Provider Name (Legal Business Name): JOHN GARY PHILLIPS M.D. (MAY 2010)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 HARDING ROAD
NASHVILLE TN
37205
US

IV. Provider business mailing address

2004 HAYES ST STE 800
NASHVILLE TN
37203-2659
US

V. Phone/Fax

Practice location:
  • Phone: 615-222-6755
  • Fax: 615-222-3567
Mailing address:
  • Phone: 615-329-0570
  • Fax: 615-329-0579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number253537
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number62949
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: