Provider Demographics
NPI:1598155434
Name:PHILLIPS, ROXANNE YVONNE (NP-C)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:YVONNE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:
Other - Last Name:FORSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1504 BROADRICK DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3011
Mailing Address - Country:US
Mailing Address - Phone:706-278-6403
Mailing Address - Fax:706-278-0087
Practice Address - Street 1:1504 BROADRICK DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3011
Practice Address - Country:US
Practice Address - Phone:706-278-6403
Practice Address - Fax:706-278-0087
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215472363L00000X
TNAPN0000021108363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner