Healthcare Provider Details

I. General information

NPI: 1457428575
Provider Name (Legal Business Name): MICHAEL THOMAS CARTWRIGHT SR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3278 MITCHELL BLVD
MOODY AFB GA
31699-2227
US

IV. Provider business mailing address

5998 COPPAGE RD
HAHIRA GA
31632-2048
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-3221
  • Fax:
Mailing address:
  • Phone: 478-919-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH019065
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13222
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: