Healthcare Provider Details

I. General information

NPI: 1861893828
Provider Name (Legal Business Name): CHRISTOPHER LAWRENCE MINER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 S COLUMBIA AVE
RINCON GA
31326-9446
US

IV. Provider business mailing address

461 S COLUMBIA AVE
RINCON GA
31326-9446
US

V. Phone/Fax

Practice location:
  • Phone: 912-584-7140
  • Fax:
Mailing address:
  • Phone: 912-584-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH028116
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: