Provider Demographics
NPI:1285699173
Name:THURMOND, GARTRELL HIRAM JR (RPH)
Entity type:Individual
Prefix:MR
First Name:GARTRELL
Middle Name:HIRAM
Last Name:THURMOND
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:670 JEFFERSON RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1616
Mailing Address - Country:US
Mailing Address - Phone:706-548-2011
Mailing Address - Fax:706-548-2193
Practice Address - Street 1:740 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5908
Practice Address - Country:US
Practice Address - Phone:706-548-4444
Practice Address - Fax:706-548-2193
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA8728OtherSTATE LICENSE