Provider Demographics
NPI:1174813976
Name:PHARMASOUTH GOVERNMENT SERVICES, LLC
Entity Type:Organization
Organization Name:PHARMASOUTH GOVERNMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDGEMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-633-0027
Mailing Address - Street 1:2915 PIEDMONT RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2782
Mailing Address - Country:US
Mailing Address - Phone:404-592-0585
Mailing Address - Fax:404-933-1388
Practice Address - Street 1:2109 FAULKNER RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4268
Practice Address - Country:US
Practice Address - Phone:404-633-0027
Practice Address - Fax:404-933-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHWH003162333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy