| NPI | 1730115619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY S GALLOWAY Owner 706-745-2303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: GA 8635) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 8635) |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: GA D19680) | |
| 3336C0004X Pharmacy Compounding Pharmacy (Licence: GA 8635) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: GA C22010) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2014-02-03 |