Kerry Louis Wilson
Organization Active NPI Community/Retail Pharmacy · Hiawassee, GA
NPI 1720156524 · NPPES record last updated Jun 18, 2015
Key facts
- NPI
- 1720156524
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 007904 (GA)
- Legal business name
- KERRY LOUIS WILSON
- Practice address
- 579 N Main St
Hiawassee, GA 30546-2219 - Phone
- (706) 896-4686
- Fax
- (706) 896-2325
- NPI assigned
- Dec 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Patti Wilson, BBA
- Title
- Co-Owner
- Phone
- (706) 896-4686
National Provider Directory
Locations
579 N Main St
Hiawassee, GA 30546
Phone (706) 896-4686
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 007904 | GA | Yes |
Addresses
Primary practice location
579 N Main St
Hiawassee, GA 30546-2219
Mailing address
579 N Main St
PO Box 385
Hiawassee, GA 30546-2219
Phone (706) 896-4686
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0116483 | Medicaid | NC | |
| 2019162 | Other | PK | |
| 00679522A | Medicaid | GA |
Other names
- CHATUGE PHARMACY
Other providers in Hiawassee, GA
- Daniel Robert Jans
- Jay S Cochran MD PC
- Barbara Fay Jockers
- Jonathan Woolfson, MD PC
- Catherine Kamin
- Kimberly Keyes
- Kilee Rayelle Smith, DO, PC
- Kimsey Enterprises, Inc.
- L Keith Sipsy DO PC
- Jeremy David Lane
All providers in Hiawassee, 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 Jun 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.