Provider Demographics
NPI:1992847990
Name:SUTTON, GREG LYNN (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:LYNN
Last Name:SUTTON
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 1:761 PRATER MILL RD NE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-7402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:79 HIGHWAY 286
Practice Address - Street 2:
Practice Address - City:ETON
Practice Address - State:GA
Practice Address - Zip Code:30724
Practice Address - Country:US
Practice Address - Phone:706-422-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist