Provider Demographics
NPI:1407569973
Name:PHILLIPS, DAMIAN (MED)
Entity Type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SLANEY LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9076
Mailing Address - Country:US
Mailing Address - Phone:240-626-1943
Mailing Address - Fax:
Practice Address - Street 1:207 SLANEY LOOP
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9076
Practice Address - Country:US
Practice Address - Phone:240-626-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch