Healthcare Provider Details

I. General information

NPI: 1801528757
Provider Name (Legal Business Name): JAMES GATES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 W PEACHTREE ST NW
ATLANTA GA
30308-1199
US

IV. Provider business mailing address

740 W PEACHTREE ST NW
ATLANTA GA
30308-1199
US

V. Phone/Fax

Practice location:
  • Phone: 866-787-6341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number019694
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: