Healthcare Provider Details

I. General information

NPI: 1881277366
Provider Name (Legal Business Name): COURTNEY C IJEOMA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 MARS HILL RD NW
ACWORTH GA
30101-7127
US

IV. Provider business mailing address

1720 MARS HILL RD NW
ACWORTH GA
30101-7127
US

V. Phone/Fax

Practice location:
  • Phone: 770-419-5495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH032684
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: