Healthcare Provider Details

I. General information

NPI: 1952935447
Provider Name (Legal Business Name): JAMES BRYAN HAZELTON PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 NEWNAN CROSSING BLVD E STE 100
NEWNAN GA
30265-2558
US

IV. Provider business mailing address

PO BOX 280
SENOIA GA
30276-0280
US

V. Phone/Fax

Practice location:
  • Phone: 770-755-9313
  • Fax: 770-755-9163
Mailing address:
  • Phone: 770-876-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH019198
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: