NPIMap

Organization Active NPI

Long's Drugs of Sandersville, Georgia, Inc.

Doing business as Avita Pharmacy 1046

  • Community/Retail Pharmacy
  • Atlanta, GA
National Provider Identifier
1437871506
Registry record updated Sep 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.
Doing business as
Avita Pharmacy 1046
Practice address
2140 Peachtree Rd NW Ste 232
Atlanta, GA 30309-1316
Phone
(404) 231-4431
NPI assigned
Sep 15, 2022
Last updated
Sep 15, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 15, 2022

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

Authorized official

Name
Ashley Ellis
Title
Corporate Counsel
Phone
(704) 641-7967

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

2140 Peachtree Rd NW Ste 232
Atlanta, GA 30309-1316

Mailing address

5700 Granite Pkwy Ste 425
Plano, TX 75024-6648

Other names 1

  • Avita Pharmacy 1046 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230110003061 GA Part B Supplier - Pharmacy 4385969609 1 other NPI on this enrollment
Practice locations: Atlanta, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Longs Drugs of Sandersville4 organizations share this tax ID, including this one
Part of
Longs Drugs of Sandersville

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1663200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663200000000",
    "number": "1437871506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 GRANITE PKWY STE 425",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750246648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 PEACHTREE RD NW STE 232",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091316",
            "telephone_number": "404-231-4431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LONG'S DRUGS OF SANDERSVILLE, GEORGIA, INC.",
        "enumeration_date": "2022-09-15",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "CORPORATE COUNSEL",
        "authorized_official_telephone_number": "704-641-7967"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Pharmacy 1046",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.