Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD0000047588 | TN |
Y | 208600000X | Surgeon | MD0000047588 | TN |
N | 208200000X | Surgeon | MD47588 | TN |
N | 208600000X | Surgeon | MD47588 | TN |
NPI | 1013120815 |
---|---|
Provider Name | Melissa Susan Phillips |
First Address | Knoxville, TN 37920 |
Second Address | Knoxville, TN 37920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 28/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1525023 | (05) | TN |