Provider Demographics
NPI:1881643443
Name:VILLIOTTE, PHILIP JAMES (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:VILLIOTTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 STARLING ST STE 107
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4266
Mailing Address - Country:US
Mailing Address - Phone:912-466-5100
Mailing Address - Fax:912-466-5113
Practice Address - Street 1:2500 STARLING ST STE 107
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4266
Practice Address - Country:US
Practice Address - Phone:912-466-5100
Practice Address - Fax:912-466-5113
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME153092085R0001X
GA846612085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME273750099Medicaid
H10664Medicare UPIN
MM8551Medicare PIN
MEMM855104Medicare PIN
MEMM855105Medicare PIN