Provider Demographics
NPI:1598856890
Name:SPALDING MEDICAL PRODUCTS
Entity Type:Organization
Organization Name:SPALDING MEDICAL PRODUCTS
Other - Org Name:HENRY'S PROFESSIONAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-228-2793
Mailing Address - Street 1:504 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4212
Mailing Address - Country:US
Mailing Address - Phone:770-228-2793
Mailing Address - Fax:770-228-8047
Practice Address - Street 1:504 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4212
Practice Address - Country:US
Practice Address - Phone:770-228-2793
Practice Address - Fax:770-228-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3720250001332B00000X
GAPHRE0051013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00021788AMedicaid
GA1123190OtherNABP
GA1123190OtherNABP