Provider Demographics
NPI:1437108123
Name:PERKINS, PHILLIP KERRY (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:KERRY
Last Name:PERKINS
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 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:615-920-8775
Practice Address - Street 1:1700 TARBORO ST W STE 100
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3481
Practice Address - Country:US
Practice Address - Phone:252-399-5314
Practice Address - Fax:252-399-5315
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34430208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00195414Medicaid
NC66885OtherBLUE CROSS
NCP00195414Medicaid
E46632Medicare UPIN