Provider Demographics
NPI:1720568033
Name:PHILLIPS, WILLIAM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:MEGGETT
Mailing Address - State:SC
Mailing Address - Zip Code:29449-6104
Mailing Address - Country:US
Mailing Address - Phone:843-813-6375
Mailing Address - Fax:
Practice Address - Street 1:716 E MANITOBA AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3842
Practice Address - Country:US
Practice Address - Phone:509-933-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant