Provider Demographics
NPI:1669132510
Name:SISSON, MARGARET-GRACE WRIGHT (PHARMD)
Entity type:Individual
Prefix:
First Name:MARGARET-GRACE
Middle Name:WRIGHT
Last Name:SISSON
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 1:200 SHALLOWFORD BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513
Mailing Address - Country:US
Mailing Address - Phone:865-314-3948
Mailing Address - Fax:
Practice Address - Street 1:6020 APPALACHIAN HWY
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4283
Practice Address - Country:US
Practice Address - Phone:706-632-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA032707Medicaid