Individual
PHILLIP POULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2202 E OGLETHORPE BLVD, ALBANY, GA 31705-2940
(229) 431-1423
Mailing address
204 N WESTOVER BLVD, ALBANY, GA 31707-2983
(229) 888-6559
(229) 436-4107
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
022622
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017231
BCBS - EAMC
GA
01
—
055019
BCBS - RHIV
GA
01
—
5199230
AETNA
GA
Enumeration date
08/31/2006
Last updated
07/08/2007
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