Provider Demographics
NPI:1497932040
Name:PHILIP, ALICE JYOTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:JYOTHI
Last Name:PHILIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2467
Mailing Address - Country:US
Mailing Address - Phone:678-807-1050
Mailing Address - Fax:770-720-7384
Practice Address - Street 1:220 OAKSIDE LN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-6413
Practice Address - Country:US
Practice Address - Phone:678-807-1050
Practice Address - Fax:770-720-7384
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine