Presbyterian Village Austell Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

PHRE009068 Issued in GA

Legal business name

PRESBYTERIAN VILLAGE AUSTELL INC

Doing business as

Presbyterian Village Pharmacy

Practice address

2000 E West Connector
Attn: Pharmacy
Austell, GA 30106-1194

Phone

(770) 819-7001

Fax

(770) 819-7494

NPI assigned

Mar 8, 2007

Last updated

Dec 8, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Debbie Heritage, PHARMD

Title

Dir of Phcy

Phone

(770) 819-7001

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• PRESBYTERIAN VILLAGE PHARMACY Doing business as

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607385600000",
    "number": "1396876793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 E WEST CONNECTOR",
            "address_2": "ATTN: PHARMACY",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061194",
            "telephone_number": "770-819-7001",
            "fax_number": "770-819-7494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 E WEST CONNECTOR",
            "address_2": "ATTN: PHARMACY",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061194",
            "telephone_number": "770-819-7001",
            "fax_number": "770-819-7494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN VILLAGE AUSTELL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "HERITAGE",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "DIR OF PHCY",
        "authorized_official_telephone_number": "770-819-7001",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "GA",
            "license": "PHRE009068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "666876218A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2017513",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRESBYTERIAN VILLAGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRESBYTERIAN VILLAGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Positive Energy Transporation Services, LLC
• Positive Pathways ABA, LLC
• Ingrid Pradere, FNP
• Jyoti Nilesh Prajapati, DDS
• Kiran Pratap, M.D.
• Presbyterian Village, Austell, Inc.
• Sarah President, F1116456
• Michelle Presley
• Louann Pressell, C.N.P
• Preventive Care Services, Inc.

• Long Term Care Pharmacy in Austell, GA
• Providers in Austell, 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 Dec 8, 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.