Individual
KEITH N PHILLIPPI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
380 HOSPITAL DRIVE, SUITE 410, MACON, GA 31217
(478) 746-5644
(478) 745-4849
Mailing address
PO BOX 2564, MACON, GA 31203
(478) 746-5644
(478) 745-4849
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036845
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000553517D
—
GA
05
—
000553517F
—
GA
05
—
000553517G
—
GA
05
—
00553517E
—
GA
01
—
036845
GA LICENSE
GA
05
—
0553517B
—
GA
05
—
0553517C
—
GA
01
—
391004
WELLCARE
GA
01
—
P00390637
RAILROAD MEDICARE
GA
Enumeration date
08/18/2005
Last updated
12/01/2020
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