Healthcare Provider Details

I. General information

NPI: 1417677584
Provider Name (Legal Business Name): DONNA MORRIS CUNNINGHAM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 EMERY HWY
MACON GA
31217-3692
US

IV. Provider business mailing address

123 STROMAN WAY
WARNER ROBINS GA
31088-2564
US

V. Phone/Fax

Practice location:
  • Phone: 478-803-7696
  • Fax:
Mailing address:
  • Phone: 478-396-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number14412
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: