Active NPI
Phillip Douglas
- Community/Retail Pharmacy
- Sandersville, GA
National Provider Identifier
1821731902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 025361
- Practice address
- 1308 S Harris St
Sandersville, GA 31082-6913 - Phone
- (478) 552-1988
- NPI assigned
- Apr 18, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 025361 | GA | Primary |
Addresses
Primary practice location
1308 S Harris St
Sandersville, GA 31082-6913
Mailing address
2908 Old US 1
Wadley, GA 30477-4010
Phone (706) 955-5029
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025361 | GA | MD | Community/Retail Pharmacy |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650240000000",
"number": "1821731902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2908 OLD US 1",
"city": "WADLEY",
"state": "GA",
"postal_code": "304774010",
"telephone_number": "706-955-5029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1308 S HARRIS ST",
"city": "SANDERSVILLE",
"state": "GA",
"postal_code": "310826913",
"telephone_number": "478-552-1988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "PHILLIP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-18",
"last_updated": "2022-04-18",
"certification_date": "2022-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "GA",
"license": "025361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandersville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.