Healthcare Provider Details

I. General information

NPI: 1083520530
Provider Name (Legal Business Name): BRIAN EDWARD HUGHES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 BRANNON DR
CANTON GA
30115-5496
US

IV. Provider business mailing address

129 BRANNON DR
CANTON GA
30115-5496
US

V. Phone/Fax

Practice location:
  • Phone: 470-233-9453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036294
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: