Provider Demographics
NPI:1043764731
Name:BOATRIGHT, PHILLIP JR (PA)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:BOATRIGHT
Suffix:JR
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 1:460 MALL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4891
Mailing Address - Country:US
Mailing Address - Phone:478-289-1303
Mailing Address - Fax:
Practice Address - Street 1:242 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2904
Practice Address - Country:US
Practice Address - Phone:800-827-6523
Practice Address - Fax:126-445-2609
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8107363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant