Provider Demographics
NPI:1083866974
Name:PHILLIPS, BRAD CLINTON (DVM)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:CLINTON
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 SPRINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8394
Mailing Address - Country:US
Mailing Address - Phone:770-266-6167
Mailing Address - Fax:
Practice Address - Street 1:1510 PIEDMONT AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5032
Practice Address - Country:US
Practice Address - Phone:404-875-7387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAVET7103174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian