Provider Demographics
NPI:1740276534
Name:PHILLIPS, BENITA L (DO)
Entity type:Individual
Prefix:
First Name:BENITA
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BENITA
Other - Middle Name:L
Other - Last Name:SWARTOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:501 LONG HOLLOW PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3448
Mailing Address - Country:US
Mailing Address - Phone:615-866-0900
Mailing Address - Fax:615-622-2447
Practice Address - Street 1:501 LONG HOLLOW PIKE STE A
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3448
Practice Address - Country:US
Practice Address - Phone:158-660-9006
Practice Address - Fax:615-622-2447
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO 810207Q00000X
TN2074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51516692OtherBLUE CROSS
AL51516692Medicaid
AL51516692OtherBLUE CROSS
AL51516692Medicaid
AL051516692Medicare ID - Type Unspecified