Wallace S Phillips (NPI# 1528166717, PAC ID# 0244283216) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA).
| Nation Provider ID (NPI) | 1528166717 |
| PAC ID by PECOS | 0244283216 |
| Professional Enrollment ID | I20050302000374 |
| Full Name | Wallace S Phillips |
| Organization Legal Name | GOOD SAMARITAN HOSPITAL, INC. |
| Address |
5401 Lake Oconee Pkwy Greensboro GA 30642-4232 |
| Phone Number | 7064537331 |
| Gender | M |
| Credential | CNA |
| Medical School | UNIVERSITY OF NEW ENGLAND, COLLEGE OF OSTEO MEDICINE |
| Graduation Year | 1995 |
| Primary Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| Group Practice PAC ID | 2668546441 |
| Number of Group Practice Members | 19 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 111329 | ST. MARY'S GOOD SAMARITAN HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 101 Lake Oconee Pakway, Eatonton, GA 31024-6054 | 7069232002 | PUTNAM GENERAL HOSPITAL |
| 5401 Lake Oconee Pkwy, Greensboro, GA 30642-4232 | 7064537331 | GOOD SAMARITAN HOSPITAL, INC. |
| Organization Legal Name | GOOD SAMARITAN HOSPITAL, INC. |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Danny A Bartlett | Certified Registered Nurse Anesthetist (crna) | Good Samaritan Hospital, Inc. | 5401 Lake Oconee Pkwy, Greensboro, GA 30642-4232 |
| Street Address |
5401 LAKE OCONEE PKWY |
| City | GREENSBORO |
| State | GA |
| Zip | 30642-4232 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Danny A Bartlett | Certified Registered Nurse Anesthetist (crna) | Good Samaritan Hospital, Inc. | 5401 Lake Oconee Pkwy, Greensboro, GA 30642-4232 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Victoria L. Albanese | Clinical Social Worker | Tendercare Clinic Inc. | 803 S Main St, Greensboro, GA 30642-1211 |
| Andrew Alexander Ke | Hospitalist | Tendercare Clinic Inc. | 803 S Main St, Greensboro, GA 30642-1211 |
| Itoro Bassey Edet Daniels | Internal Medicine | Tendercare Clinic Inc. | 803 S Main St, Greensboro, GA 30642-1211 |
| Craig B Colby | Family Medicine | Tendercare Clinic Inc. | 803 S Main St, Greensboro, GA 30642-1211 |
| Brandon Taylor | Internal Medicine | Tendercare Clinic Inc. | 803 S Main St, Greensboro, GA 30642-1211 |
| Dave A Ringer | Family Medicine | Tendercare Clinic Inc. | 803 S Main St, Greensboro, GA 30642-1211 |
| Peggy D Edmonds | Nurse Practitioner | Tendercare Clinic Inc. | 803 S Main St, Greensboro, GA 30642-1211 |
| Donna Amanda Kauffman | Nurse Practitioner | Tendercare Clinic Inc. | 803 S Main St, Greensboro, GA 30642-1211 |
| Robert T Perry | Physician Assistant | Tendercare Clinic Inc. | 803 S Main St, Greensboro, GA 30642-1211 |
| James E Southerland | General Practice | Tendercare Clinic Inc. | 803 S Main St, Greensboro, GA 30642-1211 |
| Find all physicians in zip 30642 | |||
| City | GREENSBORO |
| Zip Code | 30642 |
| Specialty | CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
| City + Specialty | GREENSBORO + CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.