Active NPI
Hayden Black, PHARMD
- Pharmacist
- Cornelia, GA
National Provider Identifier
1548859515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH030715
- Practice address
- 130 Magnolia LN
Cornelia, GA 30531-2297 - Phone
- (706) 776-3784
- Fax
- (706) 776-3788
- NPI assigned
- Jan 14, 2021
- Last updated
- Jan 14, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH030715 | GA | Primary |
Addresses
Primary practice location
130 Magnolia LN
Cornelia, GA 30531-2297
Mailing address
130 Magnolia LN
Cornelia, GA 30531-2297
Phone (706) 776-3784
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH030715 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tims Pharmacy Inc | Current | Accepting new patients | |
| Soque Pillbox LLC | Current | Accepting new patients | |
| Tims Pharmacy Inc | Past | Accepting new patients |
Locations
130 Magnolia Ln
Cornelia, GA 30531
Phone (706) 776-3070
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610582400000",
"number": "1548859515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 MAGNOLIA LN",
"city": "CORNELIA",
"state": "GA",
"postal_code": "305312297",
"telephone_number": "706-776-3784",
"fax_number": "706-776-3788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 MAGNOLIA LN",
"city": "CORNELIA",
"state": "GA",
"postal_code": "305312297",
"telephone_number": "706-776-3784",
"fax_number": "706-776-3788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "HAYDEN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-14",
"last_updated": "2021-01-14",
"certification_date": "2021-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH030715",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cornelia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.