Provider Demographics
NPI:1306184767
Name:FOUTS, MICHAEL LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LYNN
Last Name:FOUTS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:LYNN
Other - Last Name:FOUTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3316 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2308
Mailing Address - Country:US
Mailing Address - Phone:770-920-3466
Mailing Address - Fax:
Practice Address - Street 1:3316 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2308
Practice Address - Country:US
Practice Address - Phone:770-920-3466
Practice Address - Fax:770-489-6807
Is Sole Proprietor?:No
Enumeration Date:2013-01-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH009948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist