Healthcare Provider Details

I. General information

NPI: 1467846253
Provider Name (Legal Business Name): PHILLIPS HEALTHCARE GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6890 W.A.J. HWY.
TALBOTT TN
37877
US

IV. Provider business mailing address

PO BOX 879
TALBOTT TN
37877-0879
US

V. Phone/Fax

Practice location:
  • Phone: 423-839-2120
  • Fax: 423-839-2125
Mailing address:
  • Phone: 423-839-2120
  • Fax: 423-839-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD024822
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD024822
License Number StateTN

VIII. Authorized Official

Name: MR. FLOYD EDWARD PHILLIPS JR.
Title or Position: OWNER
Credential: M.D.
Phone: 423-273-0741