Provider Demographics
NPI:1659619757
Name:HANDBERRY, JAMES RUSSELL JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RUSSELL
Last Name:HANDBERRY
Suffix:JR
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 1:111 SPIDER LILY CT
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-5883
Mailing Address - Country:US
Mailing Address - Phone:404-273-4848
Mailing Address - Fax:
Practice Address - Street 1:840 GLYNN ST S
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2031
Practice Address - Country:US
Practice Address - Phone:678-817-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist