Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 046634 | GA |
NPI | 1033181318 |
---|---|
Provider Name | Thomas E Phillips |
First Address | Valdosta, GA 31602-1720 |
Second Address | Valdosta, GA 31602-1720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00834589A | (05) | GA |
G98411 | (02) |