MEDICARE: PHILLIP KERRY PERKINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	34430	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	66885	OTHER	NC	BLUE CROSS

General Provider Information

NPI Number	:	1437108123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP KERRY PERKINS MD

Provider Business Mailing Address
First Line	:	330 SEVEN SPRINGS WAY
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5098
Country	:	US
Telephone Number	:	615-920-7000
Fax Number	:	615-920-8775

Provider Business Practice Location Address
First Line	:	1700 TARBORO ST W STE 100
Second Line	:
City	:	WILSON
State	:	NC
Zip	:	27893-3481
Country	:	US
Telephone Number	:	252-399-5314
Fax Number	:	252-399-5315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	05/06/2022

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