Provider Demographics
NPI:1497730212
Name:PHILLIPS, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2051-B HAMILL ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4653
Mailing Address - Country:US
Mailing Address - Phone:423-756-8871
Mailing Address - Fax:423-475-8976
Practice Address - Street 1:2051-B HAMILL ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4653
Practice Address - Country:US
Practice Address - Phone:423-756-8871
Practice Address - Fax:423-475-8976
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN27286207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000722301DMedicaid
GA000722301DMedicaid
TN3099649Medicare ID - Type Unspecified