Healthcare Provider Details

I. General information

NPI: 1720686470
Provider Name (Legal Business Name): VANESSA W GAINES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 ROYAL DR
ALPHARETTA GA
30022-2475
US

IV. Provider business mailing address

3155 ROYAL DR
ALPHARETTA GA
30022-2475
US

V. Phone/Fax

Practice location:
  • Phone: 404-216-8409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16676
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH016676
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: