Active NPI
Ethan Gudger, PHARMD
- Pharmacist
- Canton, GA
National Provider Identifier
1780199240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH029207
- Practice address
- 450 Northside Cherokee Blvd
Canton, GA 30115-8015 - Phone
- (770) 224-1200
- NPI assigned
- Dec 6, 2017
- 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 | RPH029207 | GA | Primary |
Addresses
Primary practice location
450 Northside Cherokee Blvd
Canton, GA 30115-8015
Mailing address
450 Northside Cherokee Blvd
Canton, GA 30115-8015
Phone (770) 224-1200
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 |
|---|---|---|---|
| RPH029207 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512518400000",
"number": "1780199240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 NORTHSIDE CHEROKEE BLVD",
"city": "CANTON",
"state": "GA",
"postal_code": "301158015",
"telephone_number": "770-224-1200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 NORTHSIDE CHEROKEE BLVD",
"city": "CANTON",
"state": "GA",
"postal_code": "301158015",
"telephone_number": "770-224-1200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUDGER",
"first_name": "ETHAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-06",
"last_updated": "2017-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH029207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.