MEDICARE: HEMOPHILIA OF GEORGIA

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	333600000X	Pharmacy
2	3336S0011X	Specialty Pharmacy	PHRE007480	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2018678	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699778563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEMOPHILIA OF GEORGIA

Provider Business Mailing Address
First Line	:	8607 ROBERTS DR STE 150
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-2237
Country	:	US
Telephone Number	:	770-518-8272
Fax Number	:	770-518-3310

Provider Business Practice Location Address
First Line	:	8607 ROBERTS DR STE 150
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-2237
Country	:	US
Telephone Number	:	770-518-8272
Fax Number	:	770-518-3310

Authorized Official
Title or Position	:	CEO
Name	:	EDITH A ROSATO
Credential	:
Telephone Number	:	770-518-8272

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/05/2020

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Directions to “HEMOPHILIA OF GEORGIA ” Practice Location

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