Provider Demographics
NPI:1336104678
Name:SUMNER, JOSEPH CARL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CARL
Last Name:SUMNER
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:RR 1 BOX 2560
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-9723
Mailing Address - Country:US
Mailing Address - Phone:478-864-2217
Mailing Address - Fax:478-864-1985
Practice Address - Street 1:191 N MARCUS ST
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096-1225
Practice Address - Country:US
Practice Address - Phone:478-864-2217
Practice Address - Fax:478-864-1985
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0595480001Medicare ID - Type Unspecified