Provider Demographics
NPI:1952935447
Name:HAZELTON, JAMES BRYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRYAN
Last Name:HAZELTON
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:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-0280
Mailing Address - Country:US
Mailing Address - Phone:770-876-9910
Mailing Address - Fax:
Practice Address - Street 1:2080 NEWNAN CROSSING BLVD E STE 100
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2558
Practice Address - Country:US
Practice Address - Phone:770-755-9313
Practice Address - Fax:770-755-9163
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist