Phillips, Jerry David

Phillips, Jerry David is an individual health care provider with primary practice located at 1518 Miluli Ave , Bainbridge GA 39819-4866. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Other Service Providers / Specialist. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Phillips, Jerry David can be contacted via phone (229) 248-8500.

Contact Information

Primary practice address
1518 Miluli Ave Bainbridge GA 39819-4866
Phone: (229) 248-8500
Fax: (229) 248-8600
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 042107 Georgia
Other Service Providers / Specialist 174400000X 042107 Georgia

Profile Details

NPI number 1134133523
LBN Legal business name Phillips, Jerry David
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2006
Last updated Mar 7th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134133523 NPPES
Georgia MEDICAID 00749845F
Georgia Other 08BBQVZ

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