Basic Information
| Provider Information | |||||||||
| NPI: | 1639797921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | APRIL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | BSHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 E JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310216113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782743012 | ||||||||
| FaxNumber: | 4782747948 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 MERCER DR STE B | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310214257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782747949 | ||||||||
| FaxNumber: | 4782747948 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2020 | ||||||||
| LastUpdateDate: | 07/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.