Provider Demographics
NPI:1750366266
Name:HORTON, PHILIP ANDREW (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:ANDREW
Last Name:HORTON
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 HOSPITAL ROAD
Mailing Address - Street 2:DWIGHT D. EISENHOWER MEDICAL CENTER - 12F
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-432-3837
Mailing Address - Fax:706-432-3780
Practice Address - Street 1:300 HOSPITAL ROAD
Practice Address - Street 2:DWIGHT D. EISENHOWER MEDICAL CENTER - 12F
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-8290
Practice Address - Fax:706-787-0105
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2013-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0340812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000606317BMedicaid
GAF16482Medicare UPIN
GA26BDHWWMedicare ID - Type Unspecified