Provider Demographics
NPI:1881643443
Name:VILLIOTTE, PHILIP JAMES (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:VILLIOTTE
Suffix:
Gender:M
Credentials:MD
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 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1451 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3531
Practice Address - Country:US
Practice Address - Phone:912-490-9729
Practice Address - Fax:912-283-7337
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME153092085R0001X
GA846612085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME273750099Medicaid
H10664Medicare UPIN
MM8551Medicare PIN
MEMM855104Medicare PIN
MEMM855105Medicare PIN