Healthcare Provider Details

I. General information

NPI: 1861653891
Provider Name (Legal Business Name): JAMES E PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHEL VALLEY RD
OAK RIDGE TN
37830-8050
US

IV. Provider business mailing address

1 BETHEL VALLEY RD
OAK RIDGE TN
37830-8050
US

V. Phone/Fax

Practice location:
  • Phone: 865-574-7431
  • Fax:
Mailing address:
  • Phone: 865-574-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License NumberMD0000014226
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: