MEDICARE: DR. GREGORY ALAN SMALLWOOD PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	013002	GA

General Provider Information

NPI Number	:	1053319251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY ALAN SMALLWOOD PHARMD

Provider Business Mailing Address
First Line	:	2068 LAKEWOOD CIR
Second Line	:
City	:	GRAYSON
State	:	GA
Zip	:	30017-1267
Country	:	US
Telephone Number	:	770-778-5165
Fax Number	:	404-712-1394

Provider Business Practice Location Address
First Line	:	DEPARTMENT OF PHARMACY EG #22
Second Line	:	1364 CLIFTON RD., NE
City	:	ATLANTA
State	:	GA
Zip	:	30322-0001
Country	:	US
Telephone Number	:	404-712-7502
Fax Number	:	404-712-7577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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