Healthcare Provider Details

I. General information

NPI: 1437142304
Provider Name (Legal Business Name): JUSTINE SCHULLER GORTNEY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

IV. Provider business mailing address

1669 ROCKY TOP DR SW
LILBURN GA
30047-2594
US

V. Phone/Fax

Practice location:
  • Phone: 770-201-9640
  • Fax: 678-547-6384
Mailing address:
  • Phone: 678-935-7364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH022729
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: