Provider Demographics
NPI:1780992016
Name:GEORGE, GREGORY WILLIAM (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:GREGORY
Middle Name:WILLIAM
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 HIGHWAY 34 E
Mailing Address - Street 2:NEWNAN
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:678-423-8938
Practice Address - Street 1:3116 HIGHWAY 34 E
Practice Address - Street 2:NEWNAN
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:678-423-8938
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45856183500000X
GA24460183500000X
FL36797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist