Provider Demographics
NPI:1811024417
Name:VALUMED
Entity Type:Organization
Organization Name:VALUMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-278-4337
Mailing Address - Street 1:2705 AIRPORT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-9201
Mailing Address - Country:US
Mailing Address - Phone:706-278-4337
Mailing Address - Fax:706-278-1854
Practice Address - Street 1:2705 AIRPORT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-9201
Practice Address - Country:US
Practice Address - Phone:706-278-4337
Practice Address - Fax:706-278-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE007178183500000X, 332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00423145AMedicaid
GA110116000Medicare ID - Type Unspecified
1101160001Medicare NSC