Provider Demographics
NPI:1407018658
Name:PHILLIPS, BRANDON NICKOLAS (MD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:NICKOLAS
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRANDON
Other - Middle Name:N
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2170 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2927
Mailing Address - Country:US
Mailing Address - Phone:910-295-2100
Mailing Address - Fax:910-295-3625
Practice Address - Street 1:1212 WALTER REED RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4440
Practice Address - Country:US
Practice Address - Phone:910-930-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00748207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology