Provider Demographics
NPI:1255678850
Name:WORTZ, BRIAN D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:WORTZ
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 1:1111 LOWER FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6501
Mailing Address - Country:US
Mailing Address - Phone:770-502-2376
Mailing Address - Fax:
Practice Address - Street 1:1111 LOWER FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6501
Practice Address - Country:US
Practice Address - Phone:770-502-2376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist