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General NPI Number Information
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NPI Number | 1366555328
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Entity Type | Individual
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Provider Name | EDWARD K. PHILLIPS M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 1010 LAKELAND SQUARE EXT STE B
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City | FLOWOOD
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State | MS
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Zip | 39232-7607
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Country | US
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Telephone | 601-936-0890
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Fax | 601-936-0891
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Provider Business Mailing Address
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Address Line | 40 VALLEY STREAM PKWY STE 100
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City | MALVERN
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State | PA
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Zip | 19355-1407
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Country | US
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Telephone | 610-644-8900
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Fax | 484-924-0053
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 9170
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 09170
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License Number State | MS
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