Individual provider Active NPI

Lisa D Phillips, FNP-BC

  • Nurse Practitioner
  • Dalton, GA
National Provider Identifier
1275881823
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN247137 Issued in GA
Practice address
1436 Broadrick Dr
Suite B
Dalton, GA 30720-3009
Phone
(706) 226-3434
Fax
(706) 226-4820
NPI assigned
Aug 29, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APN16722 TN
Nurse Practitioner 363L00000X RN247137 GA Primary

Addresses

Primary practice location

1436 Broadrick Dr
Suite B
Dalton, GA 30720-3009

Mailing address

1436 Broadrick Dr
Suite B
Dalton, GA 30720-3009
Phone (706) 226-3434

Other identifiers 2

IdentifierTypeStateIssuer
003164332AMedicaidGA
03279387OtherGAAMERIGROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121121000424 TN Practitioner - Nurse Practitioner 3173774122 Reassigns benefits to 1 organization
I20151026001948 GA Practitioner - Nurse Practitioner 3173774122 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2525 Desales Ave
Chattanooga, TN 37404-1161
Phone (423) 492-4734

4710 Battlefield Pkwy
Ringgold, GA 30736-5164
Phone (423) 495-2525

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Health Partners Foundation Inc CurrentSince Aug 15, 2022 Accepting new patients
Memorial Health Partners Foundation, Inc CurrentSince Aug 15, 2022 Accepting new patients
Dalton Cardiology, P.C. Past Accepting new patients
Hamilton Medical Center, Inc. Past Accepting new patients

Locations

611 E Villanow St
La Fayette, GA 30728
Phone (706) 638-1606

2525 Desales Ave
Chattanooga, TN 37404
Phone (423) 495-2620

1032 McCallie Ave
Ste 200
Chattanooga, TN 37403
Phone (423) 693-2400

5600 Brainerd Rd
Ste 500
Chattanooga, TN 37411
Phone (423) 414-3586

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1275881823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1436 BROADRICK DR",
            "address_2": "SUITE B",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307203009",
            "telephone_number": "706-226-3434",
            "fax_number": "706-226-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 BROADRICK DR",
            "address_2": "SUITE B",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307203009",
            "telephone_number": "706-226-3434",
            "fax_number": "706-226-4820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "LISA",
        "middle_name": "D",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-29",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "APN16722",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN247137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003164332A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "03279387",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

Verify at the official NPI Registry.