Basic Information
| Provider Information | |||||||||
| NPI: | 1194806687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHLEY | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2808 18TH AVE. | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319011251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063227222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2808 18TH AVE, | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319011251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293536208 | ||||||||
| FaxNumber: | 2293537722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 05/11/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 007888 | GA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 007888 | 01 | GA | LICENSE NUMBER | OTHER |