Healthcare Provider Details

I. General information

NPI: 1609045061
Provider Name (Legal Business Name): NANCY SCARBROUGH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 LAVISTA RD NE
ATLANTA GA
30329-3951
US

IV. Provider business mailing address

2205 LAVISTA RD NE
ATLANTA GA
30329-3951
US

V. Phone/Fax

Practice location:
  • Phone: 770-633-4201
  • Fax:
Mailing address:
  • Phone: 404-633-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14709
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: