NPIMap

Organization Active NPI

Autry State Prison Pharmacy

  • Institutional Pharmacy
  • Pelham, GA
National Provider Identifier
1831689728
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
PHPR007470 Issued in GA
Legal business name
AUTRY STATE PRISON PHARMACY
Practice address
3178 Mount Zion Church Rd
Pelham, GA 31779
Phone
(229) 294-6786
Fax
(229) 294-6788
NPI assigned
May 16, 2018
Last updated
May 23, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
GEORGIA DEPARTMENT OF CORRECTIONSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 23, 2018

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

Authorized official

Name
Deena Jones Gainous, PHARMD
Title
Pharmacy Director
Phone
(229) 294-6786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X PHPR007470 GA Primary

Addresses

Primary practice location

3178 Mount Zion Church Rd
Pelham, GA 31779

Mailing address

PO Box 648
Pelham, GA 31779-0648
Phone (229) 294-6786

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2263192Autry State Prison3178 Mount Zion Church Road, Pelham, GA 31779Certificate of waiverJun 23, 2028

National Provider Directory

National Provider Directory
Tax ID family
Middle Georgia Correctional Complex Pharmacy9 organizations share this tax ID, including this one
Part of
Middle Georgia Correctional Complex Pharmacy

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3178 Mount Zion Church Rd
Pelham, GA 31779
Phone (229) 294-2940

NPI Registry JSON

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1831689728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 648",
            "city": "PELHAM",
            "state": "GA",
            "postal_code": "317790648",
            "telephone_number": "229-294-6786",
            "fax_number": "229-294-6788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3178 MOUNT ZION CHURCH RD",
            "city": "PELHAM",
            "state": "GA",
            "postal_code": "31779",
            "telephone_number": "229-294-6786",
            "fax_number": "229-294-6788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTRY STATE PRISON PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA DEPARTMENT OF CORRECTIONS",
        "enumeration_date": "2018-05-16",
        "last_updated": "2018-05-23",
        "status": "A",
        "authorized_official_last_name": "GAINOUS",
        "authorized_official_first_name": "DEENA",
        "authorized_official_middle_name": "JONES",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "229-294-6786",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "GA",
            "license": "PHPR007470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pelham, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.