Provider Demographics
NPI:1346890241
Name:PHILLIPS, BOBBI AMBER
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:AMBER
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 EISENHOWER RD
Mailing Address - Street 2:
Mailing Address - City:REBECCA
Mailing Address - State:GA
Mailing Address - Zip Code:31783-3323
Mailing Address - Country:US
Mailing Address - Phone:229-325-5132
Mailing Address - Fax:
Practice Address - Street 1:215 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-4249
Practice Address - Country:US
Practice Address - Phone:229-276-0100
Practice Address - Fax:229-276-0300
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily