Provider Demographics
NPI:1174509319
Name:PHILLIPS, DONALD MARVIN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MARVIN
Last Name:PHILLIPS
Suffix:JR
Gender:M
Credentials:DMD
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Mailing Address - Street 1:2295 PARKLAKE DR NE STE 240
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2863
Mailing Address - Country:US
Mailing Address - Phone:770-723-9965
Mailing Address - Fax:770-723-9344
Practice Address - Street 1:2295 PARKLAKE DR NE STE 240
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2863
Practice Address - Country:US
Practice Address - Phone:770-723-9965
Practice Address - Fax:770-723-9344
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2023-10-25
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Provider Licenses
StateLicense IDTaxonomies
GA013846204E00000X
SC39331223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery