Healthcare Provider Details

I. General information

NPI: 1568456259
Provider Name (Legal Business Name): MERIDETH LEIGH RADNEY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE DEPT. OF PHARMACY & DRUG INFORMATION
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

600 GARSON DR NE APT. 2203
ATLANTA GA
30324-3361
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-5633
  • Fax: 404-616-8810
Mailing address:
  • Phone: 404-791-4871
  • Fax: 404-616-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH022761
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: