Basic Information
| Provider Information | |||||||||
| NPI: | 1346890241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | BOBBI | ||||||||
| MiddleName: | AMBER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 EISENHOWER RD | ||||||||
| Address2: | |||||||||
| City: | REBECCA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317833323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293255132 | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 E 13TH AVE | ||||||||
| Address2: | |||||||||
| City: | CORDELE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310154249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292760100 | ||||||||
| FaxNumber: | 2292760300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2019 | ||||||||
| LastUpdateDate: | 09/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN227968 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.