Provider Demographics
NPI:1023659745
Name:PHILLIPS, CECIL JOHN (EDD)
Entity type:Individual
Prefix:DR
First Name:CECIL
Middle Name:JOHN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 MAPLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4113
Mailing Address - Country:US
Mailing Address - Phone:336-287-9811
Mailing Address - Fax:
Practice Address - Street 1:910 MAPLEWOOD CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4113
Practice Address - Country:US
Practice Address - Phone:336-287-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility