Provider Demographics
NPI:1962899450
Name:SEGRAVES, PHILIP
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:SEGRAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 REAGAN RUN
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5383
Mailing Address - Country:US
Mailing Address - Phone:615-573-4358
Mailing Address - Fax:
Practice Address - Street 1:5408 REAGAN RUN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-5383
Practice Address - Country:US
Practice Address - Phone:615-573-4358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care