Provider Demographics
NPI:1881462810
Name:HANSFORD, JOHN TIMOTHY SR (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TIMOTHY
Last Name:HANSFORD
Suffix:SR
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 CEDAR SHOALS DR STE A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-5299
Mailing Address - Country:US
Mailing Address - Phone:706-369-0583
Mailing Address - Fax:706-369-6742
Practice Address - Street 1:1135 CEDAR SHOALS DR STE A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-5299
Practice Address - Country:US
Practice Address - Phone:706-369-0583
Practice Address - Fax:706-369-6742
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist