Provider Demographics
NPI:1659665727
Name:ADKISSON, KATHLEEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ADKISSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 JIMMY LEE SMITH PKWY
Mailing Address - Street 2:T1400
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2739
Mailing Address - Country:US
Mailing Address - Phone:770-222-1421
Mailing Address - Fax:770-222-1421
Practice Address - Street 1:5220 JIMMY LEE SMITH PKWY
Practice Address - Street 2:T1400
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2739
Practice Address - Country:US
Practice Address - Phone:770-222-1421
Practice Address - Fax:770-222-1421
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist