Provider Demographics
NPI:1023613882
Name:SHIPP, JOHN DAWSON V
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAWSON
Last Name:SHIPP
Suffix:V
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 1:2120 BROOKTON WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7463
Mailing Address - Country:US
Mailing Address - Phone:770-846-0882
Mailing Address - Fax:
Practice Address - Street 1:206 S HARRIS ST
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-2665
Practice Address - Country:US
Practice Address - Phone:478-552-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty