=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629603014
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN BAILEY FRANKLIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2020
-----------------------------------------------------
Last Update Date | 03/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 435 TURNER MCCALL BLVD NE
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30165-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-291-3385
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 804 COLLINWOOD RD SE
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30161-6260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-835-7228
-----------------------------------------------------
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 | RPH027678
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------