Provider Demographics
NPI:1164760666
Name:PLEMMONS, KERRY EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:EDWARD
Last Name:PLEMMONS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 AIRPORT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-9201
Mailing Address - Country:US
Mailing Address - Phone:706-529-4646
Mailing Address - Fax:706-529-5226
Practice Address - Street 1:2705 AIRPORT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-9201
Practice Address - Country:US
Practice Address - Phone:706-529-4646
Practice Address - Fax:706-529-5226
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist