Healthcare Provider Details

I. General information

NPI: 1861492282
Provider Name (Legal Business Name): JAELYN L BINGHAM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD NE NORTHSIDE HOSPITAL PHARMACY
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

4678 THREE SPRINGS CT
MARIETTA GA
30062-6351
US

V. Phone/Fax

Practice location:
  • Phone: 404-303-3519
  • Fax: 404-851-8610
Mailing address:
  • Phone: 770-518-5622
  • Fax: 404-851-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH018691
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: