Advanced Medical Group LLC
Organization Active NPI Community/Retail Pharmacy · Wrens, GA
NPI 1699274167 · NPPES record last updated May 17, 2018
Key facts
- NPI
- 1699274167
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHRE010430 (GA)
- Legal business name
- ADVANCED MEDICAL GROUP LLC
- Practice address
- 206 E Broad St
Wrens, GA 30833-1109 - Phone
- (706) 547-2225
- Fax
- (706) 547-3012
- NPI assigned
- Feb 9, 2018
- Organization subpart
- No
Authorized official
- Name
- Kellie Rawlins
- Title
- VP
- Phone
- (678) 689-2389
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120801000533 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 0547337784 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Thomasville, GA; Wrens, GA |
National Provider Directory
- Tax ID family
- Langley Drug Company
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHRE010430 | GA | Yes |
Addresses
Primary practice location
206 E Broad St
Wrens, GA 30833-1109
Mailing address
PO Box 1860
Langley, SC 29834-1860
Phone (706) 547-2225
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 744933579A | Medicaid | GA | |
| 2175805 | Other | PK |
Other names
- Wrens Drug
Other providers in Wrens, GA
- Bluark Adhc Solutions
- Angela Michelle Brown
- Bryant and Hudson
- Emile Lugand Carr
- David Franklin Chance
All providers in Wrens, GA · Community/Retail Pharmacy in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.