Basic Information
| Provider Information | |||||||||
| NPI: | 1003292723 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DONALSONVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 398451511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2295242596 | ||||||||
| FaxNumber: | 2295242631 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 W 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DONALSONVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 398451511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2295242596 | ||||||||
| FaxNumber: | 2295242631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2015 | ||||||||
| LastUpdateDate: | 08/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 017200 | GA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | PS29249 | FL | N | Pharmacy Service Providers | Pharmacist |
No ID Information.