Healthcare Provider Details

I. General information

NPI: 1235717455
Provider Name (Legal Business Name): GEORGE BAZANT LAUNIUS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 S MAIN ST
MADISON GA
30650-1303
US

IV. Provider business mailing address

218 S MAIN ST
MADISON GA
30650-1303
US

V. Phone/Fax

Practice location:
  • Phone: 706-342-4141
  • Fax:
Mailing address:
  • Phone: 706-342-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11607
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: