Provider Demographics
NPI:1609151091
Name:LEDBETTER, DON (RPH)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:LEDBETTER
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 1:2701 FAIRBURN RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2941
Mailing Address - Country:US
Mailing Address - Phone:770-489-2734
Mailing Address - Fax:770-489-9652
Practice Address - Street 1:2701 FAIRBURN RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2941
Practice Address - Country:US
Practice Address - Phone:770-489-2734
Practice Address - Fax:770-489-9652
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist