Healthcare Provider Details

I. General information

NPI: 1205855129
Provider Name (Legal Business Name): CORLEY & MCCLENDON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 NORTH GREENWOOD STREET
LAGRANGE GA
30240
US

IV. Provider business mailing address

18 NEW AIRPORT ROAD SUITE B
LAGRANGE GA
30240
US

V. Phone/Fax

Practice location:
  • Phone: 706-882-4960
  • Fax: 706-882-1149
Mailing address:
  • Phone: 706-885-9213
  • Fax: 706-885-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE006331
License Number StateGA

VIII. Authorized Official

Name: MR. JAMES DAVID COCHRAN
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 706-884-2661