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General NPI Number Information
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NPI Number | 1396876793
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Entity Type | Organization
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Legal Business Name | PRESBYTERIAN VILLAGE AUSTELL INC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 2000 E WEST CONNECTOR ATTN: PHARMACY
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City | AUSTELL
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State | GA
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Zip | 30106-1194
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Country | US
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Telephone | 770-819-7001
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Fax | 770-819-7494
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Provider Business Mailing Address
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Address Line | 2000 E WEST CONNECTOR ATTN: PHARMACY
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City | AUSTELL
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State | GA
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Zip | 30106-1194
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Country | US
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Telephone | 770-819-7001
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Fax | 770-819-7494
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Authorized Official
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Title or Position | DIR OF PHCY
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Name | DEBBIE HERITAGE
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Credential | PHARMD
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Telephone | 770-819-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHRE009068
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License Number State | GA
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