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General NPI Number Information
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NPI Number | 1972103422
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Entity Type | Individual
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Provider Name | JOHN SMALL
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Gender | Male
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 2510 REDMOND CIR NW
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City | ROME
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State | GA
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Zip | 30165-1913
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Country | US
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Telephone | 706-235-3699
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Fax | 706-235-4212
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Provider Business Mailing Address
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Address Line | 2386 WILLINGTON SHOALS PL SE
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City | SMYRNA
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State | GA
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Zip | 30080-8513
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Country | US
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Telephone | 404-372-8564
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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 | RPH024925
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License Number State | GA
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