Healthcare Provider Details

I. General information

NPI: 1225025570
Provider Name (Legal Business Name): CONNIE A SIZEMORE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
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 DEPT
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

300 MADDOX PL
CANTON GA
30114-7978
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-6525
  • Fax:
Mailing address:
  • Phone: 404-851-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH019291
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: