Provider Demographics
NPI:1376557892
Name:PHILLIPS, EARL LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MSK GROUP, PC
Mailing Address - Street 2:6077 PRIMACY PARKWAY, SUITE 140
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:MSK GROUP, PC
Practice Address - Street 2:7900 AIRWAYS BLVD, STE. B102
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:662-548-2965
Practice Address - Fax:662-349-9023
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17114207X00000X
MS20473207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03908796Medicaid
TNT09680AOtherMEDICARE
MS791706OtherMEDICARE
TN1516965Medicaid