Healthcare Provider Details

I. General information

NPI: 1396175345
Provider Name (Legal Business Name): ALLCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SPRING ST
MOUNT VERNON GA
30445
US

IV. Provider business mailing address

112 S OXLEY DR
LYONS GA
30436-5645
US

V. Phone/Fax

Practice location:
  • Phone: 912-583-0066
  • Fax:
Mailing address:
  • Phone: 912-526-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009969
License Number StateGA

VIII. Authorized Official

Name: MR. ROBERT DRIGGERS
Title or Position: PRESIDENT
Credential:
Phone: 912-526-3200