Active NPI
Jerry Vance Grimmitt, RPH
- Pharmacist
- Rossville, GA
National Provider Identifier
1871668020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20271
- Practice address
- 785 Chickamauga Av
Longley Pharmacy
Rossville, GA 30741 - Phone
- (706) 866-1220
- Fax
- (706) 861-7505
- NPI assigned
- Nov 22, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 507 | TN | |
| Pharmacist | 183500000X | 20271 | GA | Primary |
| Pharmacist | 183500000X | 9494 | AL |
Addresses
Primary practice location
785 Chickamauga Av
Longley Pharmacy
Rossville, GA 30741
Mailing address
2196 Gourge Rd
Henagar, AL 35978
Phone (256) 657-3462
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 507 | TN | MD | Marriage & Family Therapist |
| 9494 | AL | MD | Pharmacist |
| 20271 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871668020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2196 GOURGE RD",
"city": "HENAGAR",
"state": "AL",
"postal_code": "35978",
"telephone_number": "256-657-3462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "785 CHICKAMAUGA AV",
"address_2": "LONGLEY PHARMACY",
"city": "ROSSVILLE",
"state": "GA",
"postal_code": "30741",
"telephone_number": "706-866-1220",
"fax_number": "706-861-7505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMMITT",
"first_name": "JERRY",
"middle_name": "VANCE",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "507",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "20271",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AL",
"license": "9494",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rossville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.