Provider Demographics
NPI:1861460883
Name:PHILLIPS, STEPHANIE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:PHILLIPS
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 1:1855 E MAIN ST STE 21A
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-2327
Mailing Address - Country:US
Mailing Address - Phone:864-913-4370
Mailing Address - Fax:833-994-1103
Practice Address - Street 1:1855 E MAIN ST STE 21A
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-2327
Practice Address - Country:US
Practice Address - Phone:864-913-4370
Practice Address - Fax:833-994-1103
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL30390207Q00000X
SC30390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8157OtherMEDICARE PTAN
H53220Medicare UPIN