Provider Demographics
NPI:1083757942
Name:COX, JEFFREY FRED (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:FRED
Last Name:COX
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 PEEBLES STILL RD
Mailing Address - Street 2:
Mailing Address - City:WHIGHAM
Mailing Address - State:GA
Mailing Address - Zip Code:39897-2464
Mailing Address - Country:US
Mailing Address - Phone:229-221-2769
Mailing Address - Fax:229-226-7812
Practice Address - Street 1:616 S BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5551
Practice Address - Country:US
Practice Address - Phone:229-226-7812
Practice Address - Fax:229-228-6223
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA020929OtherSTATE LICENSE