Provider Demographics
NPI:1487655528
Name:PHILLIPS, THOMAS WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILSON
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:770-693-6039
Practice Address - Street 1:20 GLENLAKE PKWY
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-365-0966
Practice Address - Fax:404-851-6010
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-03-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA00121122085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00144559HMedicaid
GA00144559HMedicaid
GA30BDJFDMedicare PIN