Provider Demographics
NPI:1083982714
Name:DAVID PHILLIPS & ASSOCIATES, INC.
Entity type:Organization
Organization Name:DAVID PHILLIPS & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-850-4848
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE 682
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:770-850-4848
Mailing Address - Fax:770-857-1248
Practice Address - Street 1:900 CIRCLE 75 PKWY SE
Practice Address - Street 2:SUITE 682
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3084
Practice Address - Country:US
Practice Address - Phone:770-850-4848
Practice Address - Fax:770-857-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001038103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
62TCCGMMedicare UPIN