Provider Demographics
NPI:1194727677
Name:HAGY, GEORGE MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MICHAEL
Last Name:HAGY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VILLAGE PKWY NE
Mailing Address - Street 2:#134
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4360
Mailing Address - Country:US
Mailing Address - Phone:404-316-2379
Mailing Address - Fax:
Practice Address - Street 1:15255 MAX LEGGETT PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218
Practice Address - Country:US
Practice Address - Phone:904-427-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-13
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013819183500000X
FLPS54519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist