Healthcare Provider Details

I. General information

NPI: 1164280947
Provider Name (Legal Business Name): JDF CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 N MAIN AVE
PINE MOUNTAIN GA
31822-2484
US

IV. Provider business mailing address

PO BOX 72148
ALBANY GA
31708-2148
US

V. Phone/Fax

Practice location:
  • Phone: 706-663-2255
  • Fax: 706-663-8026
Mailing address:
  • Phone: 229-435-4571
  • Fax: 229-878-4926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TRACY C ALLIGOOD
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 229-435-4571