NPI age
18 years
Enumerated 2007-11-07
Across 1965 active pharmacy providers in Georgia.
| Type | Value | Notes |
|---|---|---|
| 01 | 1115080 | NCPDP PROVIDER IDENTIFICATION NUMBER |
| 05 (GA) | 00209921A4 | |
| 05 (GA) | 176262796B |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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