Active NPI
Miriam W Douglas, PHARM D
- Pharmacist
- McDonough, GA
National Provider Identifier
1629361753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 017953
- Practice address
- 961 Highway 20 81
McDonough, GA 30253-6517 - Phone
- (770) 898-4112
- Fax
- (770) 898-8963
- NPI assigned
- May 23, 2011
- Last updated
- Sep 24, 2015
- Sex
- Female
- 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 | 017953 | GA | Primary |
Addresses
Primary practice location
961 Highway 20 81
McDonough, GA 30253-6517
Mailing address
961 Highway 20 81
McDonough, GA 30253-6517
Phone (770) 898-4112
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 |
|---|---|---|---|
| 017953 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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": "1306108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443052800000",
"number": "1629361753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "961 HIGHWAY 20 81",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302536517",
"telephone_number": "770-898-4112",
"fax_number": "770-898-8963"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "961 HIGHWAY 20 81",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302536517",
"telephone_number": "770-898-4112",
"fax_number": "770-898-8963"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "MIRIAM",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-23",
"last_updated": "2015-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "017953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McDonough, GA
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- Tanequa S Dorsey, LCSW
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- Dr. Mark J. Meininger PC
- Dr. Vivian Le Family Dentistry, PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.