Basic Information
| Provider Information | |||||||||
| NPI: | 1962769828 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | WESLEY | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | M.D, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1761 VINTON AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381045141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653851947 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7601 SOUTHCREST PKWY | ||||||||
| Address2: | |||||||||
| City: | SOUTHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627722980 | ||||||||
| FaxNumber: | 6627722960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2012 | ||||||||
| LastUpdateDate: | 04/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 52890 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 52890 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 25363 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.