Provider Demographics
NPI:1700963964
Name:PHILIPS, ATEIAT Z (MD)
Entity Type:Individual
Prefix:
First Name:ATEIAT
Middle Name:Z
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 W ARLINGTON BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5783
Mailing Address - Country:US
Mailing Address - Phone:252-752-0300
Mailing Address - Fax:252-439-5323
Practice Address - Street 1:1970 W ARLINGTON BLVD
Practice Address - Street 2:STE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5783
Practice Address - Country:US
Practice Address - Phone:252-752-0300
Practice Address - Fax:252-439-5323
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600680174400000X
NC92103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891082AMedicaid
2240646CMedicare ID - Type Unspecified
NC891082AMedicaid