Healthcare Provider Details

I. General information

NPI: 1447154083
Provider Name (Legal Business Name): LOGAN RILEY HARTZELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 RICHARD WAY
ATHENS GA
30605-4425
US

IV. Provider business mailing address

320 RICHARD WAY
ATHENS GA
30605-4425
US

V. Phone/Fax

Practice location:
  • Phone: 770-317-0920
  • Fax:
Mailing address:
  • Phone: 770-317-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHI-023069
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: