=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508586744
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AARON PHIPPS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2022
-----------------------------------------------------
Last Update Date | 08/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 199 HABERSHAM COUNTY SHOPPING CTR
-----------------------------------------------------
City | CORNELIA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30531-3412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-778-8099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 810 RUSWOOD RD
-----------------------------------------------------
City | WINDER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30680-2705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-963-8686
-----------------------------------------------------
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 | RPH033886
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------