Provider Demographics
NPI:1942226519
Name:WINES, PHILLIP A (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:WINES
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 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-7260
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:900 CONFERENCE DR
Practice Address - Street 2:SUITE 8
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072
Practice Address - Country:US
Practice Address - Phone:615-329-5144
Practice Address - Fax:615-284-2595
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD26478207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520431Medicaid
TNP00905912OtherRR MEDICARE
TN6011810OtherBLUE CROSS-BLUE SHIELD
TN1520431Medicaid
TN6011810OtherBLUE CROSS-BLUE SHIELD