Healthcare Provider Details

I. General information

NPI: 1346854866
Provider Name (Legal Business Name): NUNYA AYOVI GBEVE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 BLOOMFIELD RD
MACON GA
31206-3643
US

IV. Provider business mailing address

4080 BLOOMFIELD RD
MACON GA
31206-3643
US

V. Phone/Fax

Practice location:
  • Phone: 478-781-6821
  • Fax: 478-781-5950
Mailing address:
  • Phone: 478-781-6821
  • Fax: 478-781-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44399
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH032778
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: