Healthcare Provider Details

I. General information

NPI: 1104916667
Provider Name (Legal Business Name): AMY JOHNSON JACOBS PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N LIBERTY ST
WAYNESBORO GA
30830-3443
US

IV. Provider business mailing address

2698 SCARBORO HWY
ROCKY FORD GA
30455-6814
US

V. Phone/Fax

Practice location:
  • Phone: 706-437-8981
  • Fax:
Mailing address:
  • Phone: 912-863-6173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number018763
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: