Provider Demographics
NPI:1639161854
Name:PHILLIPS, PETER JORGEN (DPH)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JORGEN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CHOCTAW DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4642
Mailing Address - Country:US
Mailing Address - Phone:615-338-4833
Mailing Address - Fax:615-824-7556
Practice Address - Street 1:310 GREAT CIRCLE RD
Practice Address - Street 2:4TH FLOOR WEST
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37243-1700
Practice Address - Country:US
Practice Address - Phone:615-507-6436
Practice Address - Fax:615-741-0078
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044226183500000X
TN0000010933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist