Healthcare Provider Details

I. General information

NPI: 1831149178
Provider Name (Legal Business Name): THOMAS RYAN BEDDINGFIELD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 LAWRENCEVILLE HWY NW
LILBURN GA
30047-2817
US

IV. Provider business mailing address

3945 LAWRENCEVILLE HWY NW
LILBURN GA
30047-2817
US

V. Phone/Fax

Practice location:
  • Phone: 770-935-0061
  • Fax: 770-935-0069
Mailing address:
  • Phone: 770-935-0061
  • Fax: 770-935-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH 018688
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: