MEDICARE: JOHN T PHILLIPS IV 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	207R00000X	Internal Medicine Physician	056909	GA

General Provider Information

NPI Number	:	1932171568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN T PHILLIPS IV MD

Provider Business Mailing Address
First Line	:	PO BOX 2548
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31702-2548
Country	:	US
Telephone Number	:	229-312-5800
Fax Number	:	229-312-5853

Provider Business Practice Location Address
First Line	:	425 W 3RD AVE
Second Line	:	STE 340
City	:	ALBANY
State	:	GA
Zip	:	31701-1941
Country	:	US
Telephone Number	:	229-312-9150
Fax Number	:	229-312-9155

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/08/2007

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