Active NPI
Timothy John Phillips, PA-C
- Physician Assistant
- Fort Bragg, NC
National Provider Identifier
1629182639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 103731
- Practice address
- 2817 Rock Merritt Ave
Womack Army Medical Center
Fort Bragg, NC 28310-0001 - Phone
- (910) 907-6784
- Fax
- (910) 907-7907
- NPI assigned
- Aug 18, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 103731 | NC | Primary |
Addresses
Primary practice location
2817 Rock Merritt Ave
Womack Army Medical Center
Fort Bragg, NC 28310-0001
Mailing address
2817 Rock Merritt Ave
Womack Army Medical Center
Fort Bragg, NC 28310-0001
Phone (910) 907-8922
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103731 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brevard Emergency Services | Past | Accepting new patients |
Organizations & group practices 1
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.
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- Melbourne, FL
- NPI 1104870393
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1768521600000",
"number": "1629182639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2817 ROCK MERRITT AVE",
"address_2": "WOMACK ARMY MEDICAL CENTER",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283100001",
"telephone_number": "910-907-8922",
"fax_number": "910-907-6069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2817 ROCK MERRITT AVE",
"address_2": "WOMACK ARMY MEDICAL CENTER",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283100001",
"telephone_number": "910-907-6784",
"fax_number": "910-907-7907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "TIMOTHY",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-18",
"last_updated": "2026-01-16",
"certification_date": "2026-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "103731",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bragg, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.