Provider Demographics
NPI:1255572467
Name:LITTLEJOHN, JESSICA LAYNE (PHARMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAYNE
Last Name:LITTLEJOHN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S DOOLY ST
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:GA
Mailing Address - Zip Code:31063-1604
Mailing Address - Country:US
Mailing Address - Phone:478-472-7561
Mailing Address - Fax:478-472-5887
Practice Address - Street 1:549 UPPER RIVER RD
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-5312
Practice Address - Country:US
Practice Address - Phone:706-224-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHI-012475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist