Provider Demographics
NPI:1851485403
Name:STINNETT, GREGORY KEITH (RPH, DPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:KEITH
Last Name:STINNETT
Suffix:
Gender:M
Credentials:RPH, DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 E. LAKESHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-5420
Mailing Address - Country:US
Mailing Address - Phone:706-226-4193
Mailing Address - Fax:706-272-6438
Practice Address - Street 1:1200 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30722-1168
Practice Address - Country:US
Practice Address - Phone:706-272-6430
Practice Address - Fax:706-272-6438
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016188183500000X
TN21731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist