Individual
MR. WILLIE PHILLIPS II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1900 SELWYN AVE, CHARLOTTE, NC 28274-0001
(704) 337-2405
Mailing address
1900 SELWYN AVE, CHARLOTTE, NC 28274-0001
(704) 337-2405
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
LAT-3766
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000008378
NATABOC
CA
01
—
LAT-3766
NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS
NC
Enumeration date
05/31/2018
Last updated
05/31/2018
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