=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275601247
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH P SUGGS R.PH.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2006
-----------------------------------------------------
Last Update Date | 08/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2925 BROWNS BRIDGE RD
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30504-5505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-532-2266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 687
-----------------------------------------------------
City | OAKWOOD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30566-0012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-540-1015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 013576
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------