Individual
DR. KIMBERLY YOUNG PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
142 HOSPITAL PERIMETER RD, EATONTON, GA 31024-8502
(706) 485-1145
(706) 485-6025
Mailing address
142 HOSPITAL PERIMETER RD, EATONTON, GA 31024-8502
(706) 485-1145
(706) 485-6025
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
051711
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000954786C
—
GA
01
—
051711
LICENSE NUMBER
GA
01
—
20-2256065
FEDERAL TAX ID
GA
01
—
DE8801
RAILROAD MEDICARE
GA
01
—
P00322240
RAILROAD MEDICARE
GA
Enumeration date
08/07/2006
Last updated
07/24/2008
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