Guardian Pharmacy of Southeast Ga LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

PHRE008143 Issued in GA

Legal business name

GUARDIAN PHARMACY OF SOUTHEAST GA LLC

Doing business as

Guardian Pharmacy of South Georgia

Practice address

10929 Hwy 301 South
Ste 110 111
Statesboro, GA 30458

Phone

(912) 764-7839

Fax

(912) 489-1519

NPI assigned

Jul 5, 2006

Organization subpart

No

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

Authorized official

Name

Jodi Dinello

Title

President

Phone

(912) 764-7839

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• GUARDIAN PHARMACY OF SOUTH GEORGIA Doing business as

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476230400000",
    "number": "1326078007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "GUARDIAN PHARMACY OF SOUTHEAST GEORGIA DEPT 2378",
            "address_2": "P.O. BOX 11407",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352460001",
            "telephone_number": "404-810-0089",
            "fax_number": "404-810-0094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10929 HWY 301 SOUTH",
            "address_2": "STE 110 111",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "30458",
            "telephone_number": "912-764-7839",
            "fax_number": "912-489-1519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN PHARMACY OF SOUTHEAST GA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2016-10-12",
        "status": "A",
        "authorized_official_last_name": "DINELLO",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-764-7839"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "GA",
            "license": "PHRE008143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2013153",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "446858035A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GUARDIAN PHARMACY OF SOUTH GEORGIA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jillian Zofia Grantham
• Sarah Grantham, PT
• Jennifer H Gray, NP
• Ladaesha Green
• Kendall M Griffith, M.D.
• Michael Gulasey
• Keith Gunnerson
• Dina Gusby
• Giancarlo Gutierrez, DC
• Caden Cody Haas, RN

• Long Term Care Pharmacy in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Long Term Care Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.