Provider Demographics
NPI:1952617821
Name:MTM PHARMACY CONSULTANTS OF GEORGIA
Entity Type:Organization
Organization Name:MTM PHARMACY CONSULTANTS OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:912-449-8527
Mailing Address - Street 1:4953 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-4576
Mailing Address - Country:US
Mailing Address - Phone:912-449-8527
Mailing Address - Fax:
Practice Address - Street 1:4953 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-4576
Practice Address - Country:US
Practice Address - Phone:912-449-8527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA179331835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty