Provider Demographics
NPI:1922208784
Name:PHILLIPS, DEBBIE B (RFOM)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:B
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RFOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 NASH ST W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3834
Mailing Address - Country:US
Mailing Address - Phone:252-237-1188
Mailing Address - Fax:252-206-1990
Practice Address - Street 1:303 NASH ST W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3834
Practice Address - Country:US
Practice Address - Phone:252-237-1188
Practice Address - Fax:252-206-1990
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRF002166174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795225Medicaid