=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225025570
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONNIE A SIZEMORE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 JOHNSON FERRY RD NE NORTHSIDE HOSPITAL- PHARMACY DEPT
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30342-1606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-851-6525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 MADDOX PL
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30114-7978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-851-6525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | RPH019291
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------