Provider Demographics
NPI:1336867753
Name:JEFFRY, JOSEPH AUGUST
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:AUGUST
Last Name:JEFFRY
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 1:3116 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1342
Mailing Address - Country:US
Mailing Address - Phone:678-423-1549
Mailing Address - Fax:
Practice Address - Street 1:3116 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1342
Practice Address - Country:US
Practice Address - Phone:678-423-1549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist