NPIMap

Organization Active NPI

Augusta State Medical Prison

  • Institutional Pharmacy
  • Grovetown, GA
National Provider Identifier
1902397151
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
PHH006083 Issued in GA
Legal business name
AUGUSTA STATE MEDICAL PRISON
Practice address
3001 Gordon Hwy
Grovetown, GA 30813-3808
Phone
(706) 855-4744
Fax
(706) 869-7990
NPI assigned
May 23, 2018
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
Dr. Elaine Reifinger, PHARMD
Title
Pharmacy Director
Phone
(706) 855-4789

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X PHH006083 GA Primary

Addresses

Primary practice location

3001 Gordon Hwy
Grovetown, GA 30813-3808

Mailing address

3001 Gordon Hwy
Grovetown, GA 30813-3808
Phone (706) 855-4744

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
11D1032456Augusta State Medical Prison3001 Gordon Highway, Grovetown, GA 30813Certificate of waiverJun 30, 2028

National Provider Directory

National Provider Directory
Tax ID family
Georgia State Prison Regional Pharmacy9 organizations share this tax ID, including this one
Part of
Georgia State Prison Regional Pharmacy

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1902397151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 GORDON HWY",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308133808",
            "telephone_number": "706-855-4744",
            "fax_number": "706-869-7990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 GORDON HWY",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "308133808",
            "telephone_number": "706-855-4744",
            "fax_number": "706-869-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTA STATE MEDICAL PRISON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA DEPARTMENT OF CORRECTIONS",
        "enumeration_date": "2018-05-23",
        "last_updated": "2018-05-23",
        "status": "A",
        "authorized_official_last_name": "REIFINGER",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "706-855-4789",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "GA",
            "license": "PHH006083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grovetown, 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.