Provider Demographics
NPI:1740247105
Name:PHILLIPS, JAMES WIGHT (PAC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WIGHT
Last Name:PHILLIPS
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Gender:M
Credentials:PAC
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Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:ATTN. MANAGED CARE PLANNING
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309
Mailing Address - Country:US
Mailing Address - Phone:910-615-6949
Mailing Address - Fax:910-615-9761
Practice Address - Street 1:2817 REILLY RD
Practice Address - Street 2:MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2016-12-16
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Provider Licenses
StateLicense IDTaxonomies
NC001000397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant