Provider Demographics
NPI:1679630149
Name:GUNN, JOHN DAVID (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:GUNN
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 1:145 GREEN STREET
Mailing Address - Street 2:PO BOX 56
Mailing Address - City:WADLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30477
Mailing Address - Country:US
Mailing Address - Phone:478-252-5626
Mailing Address - Fax:478-252-1770
Practice Address - Street 1:48 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WADLEY
Practice Address - State:GA
Practice Address - Zip Code:30477
Practice Address - Country:US
Practice Address - Phone:478-252-5252
Practice Address - Fax:478-252-1770
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist