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General NPI Number Information
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NPI Number | 1649953902
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Entity Type | Individual
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Provider Name | JESSICA MORGAN BOATNER PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 730 N MAIN ST
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City | CEDARTOWN
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State | GA
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Zip | 30125-2358
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Country | US
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Telephone | 770-749-5095
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Fax |
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Provider Business Mailing Address
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Address Line | 5906 BLACKS BLUFF RD SW
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City | CAVE SPRING
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State | GA
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Zip | 30124-2192
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Country | US
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Telephone | 706-622-1232
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Fax |
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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 | 034409
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License Number State | GA
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