Provider Demographics
NPI:1295850881
Name:NEAL, LLINTON M
Entity type:Individual
Prefix:
First Name:LLINTON
Middle Name:M
Last Name:NEAL
Suffix:
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 1:501 MOUNT PLEASANT RD
Mailing Address - Street 2:P.O. BOX 336
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-8140
Mailing Address - Country:US
Mailing Address - Phone:706-595-6126
Mailing Address - Fax:706-597-1449
Practice Address - Street 1:501 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-8140
Practice Address - Country:US
Practice Address - Phone:706-595-6126
Practice Address - Fax:706-597-1449
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00031116AMedicaid
GA3984050001Medicare ID - Type UnspecifiedMEDICARE NUMBER