Healthcare Provider Details

I. General information

NPI: 1871584383
Provider Name (Legal Business Name): JOHN B PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/20/2011
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:
Title or Position:
Credential:
Phone: