Healthcare Provider Details

I. General information

NPI: 1235054081
Provider Name (Legal Business Name): VALLEY FORGE DYNAMICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 8TH AVE APT 2
ALBANY GA
31701-1600
US

IV. Provider business mailing address

2800 OLD DAWSON RD STE 2
ALBANY GA
31707-1413
US

V. Phone/Fax

Practice location:
  • Phone: 229-343-5753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN HAWKINS
Title or Position: ORGANIZER
Credential:
Phone: 229-343-5753