Provider Demographics
NPI:1972570372
Name:PHILLIPS, JAMES HARRISON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HARRISON
Last Name:PHILLIPS
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 1:1280 JOHNNIE DODDS BLVD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3285
Mailing Address - Country:US
Mailing Address - Phone:843-284-4799
Mailing Address - Fax:843-284-4798
Practice Address - Street 1:1280 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3287
Practice Address - Country:US
Practice Address - Phone:843-284-4799
Practice Address - Fax:843-284-4798
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8871207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC088719Medicaid
D05518Medicare UPIN
SC088719Medicaid
SCP00441607Medicare PIN