=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346530458
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STANLEY GARNER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2011
-----------------------------------------------------
Last Update Date | 04/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1775 MARS HILL RD NW
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30101-4555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-919-0882
-----------------------------------------------------
Fax | 770-919-9984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1775 MARS HILL RD NW
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30101-4555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-919-0882
-----------------------------------------------------
Fax | 770-919-9984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH020586
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------