Healthcare Provider Details

I. General information

NPI: 1578768545
Provider Name (Legal Business Name): BALL GROUND PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 GILMER FERRY RD
BALL GROUND GA
30107-2908
US

IV. Provider business mailing address

245 GILMER FERRY RD
BALL GROUND GA
30107-2908
US

V. Phone/Fax

Practice location:
  • Phone: 770-735-6161
  • Fax: 770-735-6925
Mailing address:
  • Phone: 770-735-6161
  • Fax: 770-735-6925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHRE007345
License Number StateGA

VIII. Authorized Official

Name: JEFF RICHARDSON
Title or Position: OWNER
Credential:
Phone: 770-735-6161