Provider Demographics
NPI:1821366311
Name:NUSSBAUMER, GINA CATHERINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:CATHERINE
Last Name:NUSSBAUMER
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 1:7401 BLACKMON RD
Mailing Address - Street 2:APT 2203
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4489
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3700 MACON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2248
Practice Address - Country:US
Practice Address - Phone:706-568-6878
Practice Address - Fax:706-568-6639
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024630183500000X
COPHA18156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist