Individual
JERRY DAVID PHILLIPS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1518 MILULI AVE, BAINBRIDGE, GA 39819-4866
(229) 248-8500
(229) 248-8600
Mailing address
1518 MILULI AVE, BAINBRIDGE, GA 39819-4866
(229) 248-8500
(229) 248-8600
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
042107
GA
207Q00000X
Family Medicine Physician
Primary
042107
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00749845F
—
GA
01
—
08BBQVZ
MEDICARE-ID
GA
Enumeration date
07/28/2006
Last updated
03/07/2019
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