Provider Demographics
NPI:1932781994
Name:PHILLIPS, JAMMIE (MED, EDS, RBT)
Entity Type:Individual
Prefix:
First Name:JAMMIE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MED, EDS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 HILLY CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4665
Mailing Address - Country:US
Mailing Address - Phone:404-492-3712
Mailing Address - Fax:
Practice Address - Street 1:520 HILLY CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-4665
Practice Address - Country:US
Practice Address - Phone:404-492-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-165621106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician