Individual
PHILLIP A WINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 CONFERENCE DR, SUITE 8, GOODLETTSVILLE, TN 37072
(615) 329-5144
(615) 284-2595
Mailing address
300 20TH AVE N STE 403, NASHVILLE, TN 37203-5180
(615) 284-7260
(615) 284-7501
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD26478
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1520431
—
TN
01
—
6011810
BLUE CROSS-BLUE SHIELD
TN
01
—
P00905912
RR MEDICARE
TN
Enumeration date
07/15/2006
Last updated
07/10/2018
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