NPIMap

Organization Active NPI

McIntosh Trail CSB

Doing business as BHC Pharmacy

  • Clinic Pharmacy
  • Griffin, GA
National Provider Identifier
1932368974
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
PHRE005229 Issued in GA
Legal business name
MCINTOSH TRAIL CSB
Doing business as
BHC Pharmacy
Practice address
1501A Kalamazoo Dr
Griffin, GA 30224-3919
Phone
(770) 358-8250
Fax
(770) 229-3223
NPI assigned
Jun 5, 2008
Last updated
Jun 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Pamela McCollum
Title
Executive Director
Phone
(770) 358-8251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X PHRE005229 GA Primary

Addresses

Primary practice location

1501A Kalamazoo Dr
Griffin, GA 30224-3919

Mailing address

136 N Hill St
Griffin, GA 30223-3335
Phone (770) 229-3000

Other identifiers 2

IdentifierTypeStateIssuer
000251666AMedicaidGA
1123645OtherGANCPDP

Other names 1

  • BHC Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
McIntosh Trail CSB29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1212624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1932368974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 N HILL ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302233335",
            "telephone_number": "770-229-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501A KALAMAZOO DR",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302243919",
            "telephone_number": "770-358-8250",
            "fax_number": "770-229-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCINTOSH TRAIL CSB",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-05",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "MCCOLLUM",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "770-358-8251"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "GA",
            "license": "PHRE005229",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000251666A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1123645",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BHC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Griffin, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.