Provider Demographics
NPI:1902941461
Name:PHILLIPS, DONNA BOWERS (DDS)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:BOWERS
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DDS
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 1613
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31310-8613
Mailing Address - Country:US
Mailing Address - Phone:912-876-3200
Mailing Address - Fax:912-876-3236
Practice Address - Street 1:745 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2542
Practice Address - Country:US
Practice Address - Phone:912-876-3200
Practice Address - Fax:912-876-3236
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0101161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00545575BMedicaid