Provider Demographics
NPI:1932450293
Name:DJTR HOLDINGS INC
Entity Type:Organization
Organization Name:DJTR HOLDINGS INC
Other - Org Name:CROSSROADS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-435-4571
Mailing Address - Street 1:PO BOX 72148
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2148
Mailing Address - Country:US
Mailing Address - Phone:229-435-4571
Mailing Address - Fax:229-435-7069
Practice Address - Street 1:7838 HIGHWAY 48
Practice Address - Street 2:
Practice Address - City:MENLO
Practice Address - State:GA
Practice Address - Zip Code:30731-6337
Practice Address - Country:US
Practice Address - Phone:706-862-2064
Practice Address - Fax:706-862-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
GAPHRE0098723336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137023OtherPK
GA003128088AMedicaid
AL143107Medicaid
7535480001Medicare NSC
202G738088Medicare PIN