1780295774 NPI number — DR. MARTHA MYERS HONEYCUTT PHARMD

Table of content: DR. MARTHA MYERS HONEYCUTT PHARMD (NPI 1780295774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780295774 NPI number — DR. MARTHA MYERS HONEYCUTT PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HONEYCUTT
Provider First Name:
MARTHA
Provider Middle Name:
MYERS
Provider Name Prefix Text:
DR.
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:
MYERS
Provider Other First Name:
MARTHA
Provider Other Middle Name:
BRYAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1780295774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3625 BATTLEFIELD PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FT OGLETHORPE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30742-4001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-866-1839
Provider Business Mailing Address Fax Number:
706-866-1845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3625 BATTLEFIELD PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT OGLETHORPE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30742-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-866-1839
Provider Business Practice Location Address Fax Number:
706-866-1845
Provider Enumeration Date:
08/12/2020

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:  42888 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: RPH030853 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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