Provider Demographics
NPI:1366464331
Name:DUBBERLY, JERRY LENDON (PHARMACIST (PHARMD))
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LENDON
Last Name:DUBBERLY
Suffix:
Gender:M
Credentials:PHARMACIST (PHARMD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 PARK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3772
Mailing Address - Country:US
Mailing Address - Phone:770-772-1635
Mailing Address - Fax:404-656-8366
Practice Address - Street 1:2 PEACHTREE ST NW
Practice Address - Street 2:37TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3181
Practice Address - Country:US
Practice Address - Phone:404-657-9092
Practice Address - Fax:404-656-8366
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist