Provider Demographics
NPI:1275699167
Name:ADAIRSVILLE DRUG INC
Entity Type:Organization
Organization Name:ADAIRSVILLE DRUG INC
Other - Org Name:ADAIRSVILLE DRUG INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-773-3521
Mailing Address - Street 1:6000 JOE FRANK HARRIS PKWY NW
Mailing Address - Street 2:SUITE F
Mailing Address - City:ADAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30103-2443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6000 JOE FRANK HARRIS PKWY NW
Practice Address - Street 2:SUITE F
Practice Address - City:ADAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30103-2443
Practice Address - Country:US
Practice Address - Phone:770-773-3521
Practice Address - Fax:770-773-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0060133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104164OtherNCPDP PROVIDER IDENTIFICATION NUMBER
GA00249323AMedicaid