Healthcare Provider Details

I. General information

NPI: 1811972482
Provider Name (Legal Business Name): INNOVATIVE HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 RAILROAD ST
COBBTOWN GA
30420-6012
US

IV. Provider business mailing address

150 S LEROY ST
METTER GA
30439-4631
US

V. Phone/Fax

Practice location:
  • Phone: 912-684-2765
  • Fax: 912-684-2029
Mailing address:
  • Phone: 912-685-2803
  • Fax: 912-685-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. BOBBY DEAN STONE JR.
Title or Position: OWNER/PHARMACIST
Credential: R.PH., CDM
Phone: 912-684-2765