Healthcare Provider Details

I. General information

NPI: 1689812935
Provider Name (Legal Business Name): JOHN MACHAYO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2009
Last Update Date: 01/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 S ATLANTA RD SE
SMYRNA GA
30080-7031
US

IV. Provider business mailing address

1697 HARLINGTON RD
SMYRNA GA
30082-5056
US

V. Phone/Fax

Practice location:
  • Phone: 404-792-6980
  • Fax: 404-792-6983
Mailing address:
  • Phone: 770-405-8383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH018612
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: