=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821335514
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN CHRISTOPHER JAMISON PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2013
-----------------------------------------------------
Last Update Date | 01/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1114 GA HIGHWAY 96
-----------------------------------------------------
City | KATHLEEN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31047-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-987-6788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 SASSER DR
-----------------------------------------------------
City | BONAIRE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31005-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-918-4622
-----------------------------------------------------
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 | RPH026879
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------