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NPI Code Detail

MEDICARE: WILLIAM PHILLIPS PA

MEDICARE: WILLIAM 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
1363A00000XPhysician Assistant003929GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1003929OTHERGAPA LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679563613
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM PHILLIPS PA
Provider Business Mailing Address
First Line : 210 E DE RENNE AVE
Second Line :
City : SAVANNAH
State : GA
Zip : 31405-6736
Country : US
Telephone Number : 912-644-5372
Fax Number : 912-644-5260
Provider Business Practice Location Address
First Line : 210 E DE RENNE AVE
Second Line :
City : SAVANNAH
State : GA
Zip : 31405-6736
Country : US
Telephone Number : 912-644-5372
Fax Number : 912-644-5260
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 05/15/2017

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Directions to “ WILLIAM PHILLIPS PA” Practice Location

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