NPIMap

Organization Active NPI

Olde Time Pharmacy at Sixes, LLC

  • Clinic/Center
  • Holly Springs, GA
National Provider Identifier
1831476316
Registry record updated Nov 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
PHRE009711 Issued in GA
Legal business name
OLDE TIME PHARMACY AT SIXES, LLC
Practice address
684 Sixes Rd
Suite 105
Holly Springs, GA 30115-8721
Phone
(678) 445-4486
Fax
(678) 445-3536
NPI assigned
Nov 10, 2011
Last updated
Nov 10, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shad SutherlandNPI 1336739663
Title
Manager
Phone
(678) 445-4486

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X PHRE009711 GA Primary

Addresses

Primary practice location

684 Sixes Rd
Suite 105
Holly Springs, GA 30115-8721

Mailing address

684 Sixes Rd
Suite 105
Holly Springs, GA 30115-8721
Phone (678) 445-4486

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320883200000",
    "number": "1831476316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "684 SIXES RD",
            "address_2": "SUITE 105",
            "city": "HOLLY SPRINGS",
            "state": "GA",
            "postal_code": "301158721",
            "telephone_number": "678-445-4486",
            "fax_number": "678-445-3536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "684 SIXES RD",
            "address_2": "SUITE 105",
            "city": "HOLLY SPRINGS",
            "state": "GA",
            "postal_code": "301158721",
            "telephone_number": "678-445-4486",
            "fax_number": "678-445-3536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLDE TIME PHARMACY AT SIXES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-10",
        "last_updated": "2011-11-10",
        "status": "A",
        "authorized_official_last_name": "SUTHERLAND",
        "authorized_official_first_name": "SHAD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "678-445-4486"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "GA",
            "license": "PHRE009711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holly Springs, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.