Healthcare Provider Details

I. General information

NPI: 1972593341
Provider Name (Legal Business Name): WYNNS HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 S 8TH ST
GRIFFIN GA
30224-4212
US

IV. Provider business mailing address

566 S 8TH ST
GRIFFIN GA
30224-4212
US

V. Phone/Fax

Practice location:
  • Phone: 770-227-9432
  • Fax: 770-229-4078
Mailing address:
  • Phone: 770-227-9432
  • Fax: 770-229-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE006081
License Number StateGA

VIII. Authorized Official

Name: ANNETTE W DUNCAN
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 770-227-9432