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General NPI Number Information
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NPI Number | 1760872808
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Entity Type | Individual
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Provider Name | CHARLES HENRY PHILLIPS III P.A.
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Gender | Male
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 02/15/2026
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Provider Practice Location Address
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Address Line | 1915 W PARK DR STE 103
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-3777
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Country | US
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Telephone | 336-838-9553
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 W PARK DR STE 103
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-3777
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Country | US
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Telephone | 336-838-9553
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110005603
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-05417
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 41019
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License Number State | MT
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