Provider Demographics
NPI:1720386774
Name:LUNCEFORD, ALBERT G (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:G
Last Name:LUNCEFORD
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 1:975 HIGHWAY 54 W
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4500
Mailing Address - Country:US
Mailing Address - Phone:770-719-3340
Mailing Address - Fax:770-719-5176
Practice Address - Street 1:975 HIGHWAY 54 W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4500
Practice Address - Country:US
Practice Address - Phone:770-719-3340
Practice Address - Fax:770-719-5176
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist