Provider Demographics
NPI:1558839688
Name:DUNCAN, GINA MICHELLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MICHELLE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:MICHELLE
Other - Last Name:GOFORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1730 SHADY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-8625
Mailing Address - Country:US
Mailing Address - Phone:770-366-5964
Mailing Address - Fax:
Practice Address - Street 1:271 E COURT SQ
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:GA
Practice Address - Zip Code:30217-8012
Practice Address - Country:US
Practice Address - Phone:706-675-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty