Active NPI
Willie Phillips II, ATC
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Charlotte, NC
National Provider Identifier
1154813756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- LAT-3766
- Practice address
- 1900 Selwyn Ave
Charlotte, NC 28274-0001 - Phone
- (704) 337-2405
- NPI assigned
- May 31, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | LAT-3766 | NC | Primary |
Addresses
Primary practice location
1900 Selwyn Ave
Charlotte, NC 28274-0001
Mailing address
1900 Selwyn Ave
Charlotte, NC 28274-0001
Phone (704) 337-2405
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LAT-3766 | Other | NC | NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS |
| 2000008378 | Other | CA | NATABOC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAT-3766 | NC | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527724800000",
"number": "1154813756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 SELWYN AVE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282740001",
"telephone_number": "704-337-2405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 SELWYN AVE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282740001",
"telephone_number": "704-337-2405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "WILLIE",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-31",
"last_updated": "2018-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "NC",
"license": "LAT-3766",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS",
"identifier": "LAT-3766",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATABOC",
"identifier": "2000008378",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.