Provider Demographics
NPI:1679749758
Name:THE HARVILLE GROUP
Entity Type:Organization
Organization Name:THE HARVILLE GROUP
Other - Org Name:ATLANTA PHARMACY & MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-672-7976
Mailing Address - Street 1:1395 S. MARIETTA PKWY SE
Mailing Address - Street 2:BLDG 400-105
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067
Mailing Address - Country:US
Mailing Address - Phone:770-672-7976
Mailing Address - Fax:770-672-7975
Practice Address - Street 1:1395 S MARIETTA PKWY SE
Practice Address - Street 2:BLDG 400-105
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4440
Practice Address - Country:US
Practice Address - Phone:770-672-7976
Practice Address - Fax:770-672-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHHH0000513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA184103243AMedicaid
GA6124410002Medicare NSC