Provider Demographics
NPI:1861292450
Name:PHILLIPS, LAURA C
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 DUE SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WHIGHAM
Mailing Address - State:GA
Mailing Address - Zip Code:39897-4019
Mailing Address - Country:US
Mailing Address - Phone:229-220-4288
Mailing Address - Fax:
Practice Address - Street 1:249 DUE SOUTH RD
Practice Address - Street 2:
Practice Address - City:WHIGHAM
Practice Address - State:GA
Practice Address - Zip Code:39897-4019
Practice Address - Country:US
Practice Address - Phone:229-220-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program