Provider Demographics
NPI:1033417399
Name:PHILLIPS, PERCY AUDREY JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:PERCY
Middle Name:AUDREY
Last Name:PHILLIPS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WINDING CREEK LN
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-7700
Mailing Address - Country:US
Mailing Address - Phone:229-226-1572
Mailing Address - Fax:
Practice Address - Street 1:301 S BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5546
Practice Address - Country:US
Practice Address - Phone:229-228-7658
Practice Address - Fax:229-228-4503
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist