MEDICARE: CHARLES T PHILLIPS PA

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	363AM0700X	Medical Physician Assistant	PA9100695	FL
2	363AM0700X	Medical Physician Assistant	0010-01113	NC

General Provider Information

NPI Number	:	1538164298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES T PHILLIPS PA

Provider Business Mailing Address
First Line	:	1600 PERIMETER PARK DR
Second Line	:	SUITE 225
City	:	MORRISVILLE
State	:	NC
Zip	:	27560-8421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 NASH MEDICAL ARTS MALL
Second Line	:	SUITE D
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-1470
Country	:	US
Telephone Number	:	252-962-5300
Fax Number	:

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	10/22/2015

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Directions to “ CHARLES T PHILLIPS PA” Practice Location

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