MEDICARE: DR. GREGORY BRIAN SEAGRAVES PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH022133	GA

General Provider Information

NPI Number	:	1588978126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY BRIAN SEAGRAVES PHARM D

Provider Business Mailing Address
First Line	:	150 CLEVELAND RD
Second Line	:	SUITE A
City	:	BOGART
State	:	GA
Zip	:	30622-1701
Country	:	US
Telephone Number	:	706-369-9591
Fax Number	:	706-369-9698

Provider Business Practice Location Address
First Line	:	150 CLEVELAND RD
Second Line	:	SUITE A
City	:	BOGART
State	:	GA
Zip	:	30622-1701
Country	:	US
Telephone Number	:	706-369-9591
Fax Number	:	706-369-9698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	08/05/2010

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