Marla Marie Mitcham, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

RPH029883 Issued in GA

Practice address

100 Myrtle Blvd.
Pharmacy BLDG. 15 Room G12
Gracewood, GA 30812

Phone

(706) 790-2496

Fax

(706) 790-2340

NPI assigned

Aug 20, 2020

Last updated

Aug 20, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1043822067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MYRTLE BLVD.",
            "address_2": "PHARMACY BLDG. 15 ROOM G12",
            "city": "GRACEWOOD",
            "state": "GA",
            "postal_code": "30812",
            "telephone_number": "706-790-2496",
            "fax_number": "706-790-2340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MYRTLE BLVD.",
            "address_2": "PHARMACY BLDG. 15 ROOM G12",
            "city": "GRACEWOOD",
            "state": "GA",
            "postal_code": "30812",
            "telephone_number": "706-790-2496",
            "fax_number": "706-790-2340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHAM",
        "first_name": "MARLA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-20",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH029883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "RPH029883",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald Alan Hyman, M.D.
• Gail Cole Jackson, M.D.
• Cynthia Bass Kucela, RPH
• Terri E Lawless, M.D.
• Melissa B Lynch
• Eliza A Myers, D.M.D.
• Holli E Pender, PHARMD.
• Sopheap Pin, PHARMD
• Martin Saumweber Jr., M.D.
• Denise W Smith, M.D.

• Pharmacist in Gracewood, GA
• Providers in Gracewood, GA by specialty
• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.