Provider Demographics
NPI:1679842355
Name:ENNIN, FRANCIS K
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:K
Last Name:ENNIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 PEEL CASTLE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1467
Mailing Address - Country:US
Mailing Address - Phone:404-931-6117
Mailing Address - Fax:
Practice Address - Street 1:947 PEEL CASTLE LN
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1467
Practice Address - Country:US
Practice Address - Phone:404-931-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020181183500000X
MI5302031718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist