1881728749 NPI number — GEORGIA REGIONAL HOSPITAL PHARMACY

Table of content: (NPI 1881728749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881728749 NPI number — GEORGIA REGIONAL HOSPITAL PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA REGIONAL HOSPITAL PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881728749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 370407
Provider Second Line Business Mailing Address:
PATIENT ACCOUNTS OFFICE
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30034-3828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-243-2158
Provider Business Mailing Address Fax Number:
404-243-2159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3073 PANTHERSVILLE ROAD
Provider Second Line Business Practice Location Address:
PATIENT ACCOUNTS OFFICE
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30034-3828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-243-2158
Provider Business Practice Location Address Fax Number:
404-243-2159
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SLATE
Authorized Official First Name:
SONNY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATIONS OFFICER
Authorized Official Telephone Number:
404-243-2121

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  044-232 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000355715A . This is a "PHARMACY PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1119723 . This is a "PHARMACY" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com