Provider Demographics
NPI:1649751025
Name:BLANTON, ERIC AUSTIN (RPH)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:AUSTIN
Last Name:BLANTON
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 1:74 BRIANDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6240
Mailing Address - Country:US
Mailing Address - Phone:229-548-7500
Mailing Address - Fax:
Practice Address - Street 1:100 GLENDA TRCE
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3863
Practice Address - Country:US
Practice Address - Phone:770-502-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist