1770516973 NPI number — CORLEY & MCCLENDON INC.

Table of content: (NPI 1770516973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770516973 NPI number — CORLEY & MCCLENDON INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORLEY & MCCLENDON INC.
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:
CORLEY DRUGS #1
Provider Other Organization Name Type Code:
3
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:
1770516973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 NEW AIRPORT ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGRANGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-885-9213
Provider Business Mailing Address Fax Number:
706-885-9829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
523 SOUTH GREENWOOD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-884-2661
Provider Business Practice Location Address Fax Number:
706-884-5446
Provider Enumeration Date:
07/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COCHRAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
RPH
Authorized Official Telephone Number:
706-884-2661

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHRE004797 , 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: PHRE004797 . This is a "STATE PHARMACY LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00069715A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1770516973 . This is a "NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".