Provider Demographics
NPI:1992788822
Name:SKEEN, PHILLIP MARK (PA)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:MARK
Last Name:SKEEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749306
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9306
Mailing Address - Country:US
Mailing Address - Phone:843-492-2710
Mailing Address - Fax:
Practice Address - Street 1:2761 AGNES LN
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2029
Practice Address - Country:US
Practice Address - Phone:843-492-2710
Practice Address - Fax:843-492-2708
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2024-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4667363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant