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General NPI Number Information
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NPI Number | 1366464331
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Entity Type | Individual
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Provider Name | JERRY LENDON DUBBERLY PHARMACIST (PHARMD)
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2 PEACHTREE ST NW 37TH FLOOR
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City | ATLANTA
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State | GA
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Zip | 30303-3181
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Country | US
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Telephone | 404-657-9092
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Fax | 404-656-8366
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Provider Business Mailing Address
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Address Line | 370 PARK CREEK DR
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City | ALPHARETTA
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State | GA
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Zip | 30005-3772
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Country | US
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Telephone | 770-772-1635
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Fax | 404-656-8366
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 019036
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License Number State | GA
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