Provider Demographics
NPI:1679598122
Name:GROOMS, PHILLIP G (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:G
Last Name:GROOMS
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:P.O. BOX 764
Mailing Address - Street 2:170 THORN RD
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510
Mailing Address - Country:US
Mailing Address - Phone:912-632-6753
Mailing Address - Fax:
Practice Address - Street 1:515 CITY BLVD STE B
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-8016
Practice Address - Country:US
Practice Address - Phone:912-279-4400
Practice Address - Fax:912-279-4408
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL24429207P00000X
GA026781207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine