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General NPI Number Information
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NPI Number | 1093533978
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Entity Type | Individual
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Provider Name | GALEN PHILLIPS NP
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Gender | Female
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 7276 SOUTHCREST PKWY
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City | SOUTHAVEN
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State | MS
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Zip | 38671-4760
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Country | US
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Telephone | 662-349-6577
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Fax | 662-349-6562
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Provider Business Mailing Address
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Address Line | 1 PARIS DR
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City | INDIANOLA
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State | MS
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Zip | 38751-2019
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Country | US
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Telephone | 662-822-0027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 906987
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License Number State | MS
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