Registry details
Type
Individual
Primary specialty
Pharmacist
Enumerated
Dec 10, 2019
License(s)
014100 (GA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 175 JACOB CT | Fayetteville, GA 30214-7541 | 404-201-5544 |
| LOCATION | 175 JACOB CT | Fayetteville, GA 30214-7541 | 404-201-5544 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.