1982096848 NPI number — MRS. BRITTANI MCLEOD GRINSTEAD PHARMD

Table of content: MRS. BRITTANI MCLEOD GRINSTEAD PHARMD (NPI 1982096848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982096848 NPI number — MRS. BRITTANI MCLEOD GRINSTEAD PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRINSTEAD
Provider First Name:
BRITTANI
Provider Middle Name:
MCLEOD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCLEOD
Provider Other First Name:
BRITTANI
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982096848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 65
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAWKINSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31036-0065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-783-4556
Provider Business Mailing Address Fax Number:
478-783-4552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 COMMERCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWKINSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31036-8431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-783-4556
Provider Business Practice Location Address Fax Number:
478-783-4552
Provider Enumeration Date:
03/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH026244 , 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)





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