Provider Demographics
NPI:1063503654
Name:PHILLIPS, THOMAS R (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2734 N HILLS DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3421
Mailing Address - Country:US
Mailing Address - Phone:404-721-0797
Mailing Address - Fax:404-953-7517
Practice Address - Street 1:2734 N HILLS DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3421
Practice Address - Country:US
Practice Address - Phone:404-721-0797
Practice Address - Fax:404-953-7517
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA62TCCJSMedicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST