Healthcare Provider Details

I. General information

NPI: 1326069915
Provider Name (Legal Business Name): JOHN B PHILLIPS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SKYLINE LN
PARSONS TN
38363-2345
US

IV. Provider business mailing address

50 SKYLINE LN
PARSONS TN
38363-2345
US

V. Phone/Fax

Practice location:
  • Phone: 731-847-6373
  • Fax: 731-847-6579
Mailing address:
  • Phone: 731-847-6373
  • Fax: 731-847-6579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000010756
License Number StateTN

VIII. Authorized Official

Name: DR. JOHN B PHILLIPS
Title or Position: OWNER
Credential: M.D.
Phone: 731-847-6373