Provider Demographics
NPI:1386704070
Name:FAIRMOUNT DRUGS INC
Entity type:Organization
Organization Name:FAIRMOUNT DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BHAVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-337-5461
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT
Mailing Address - State:GA
Mailing Address - Zip Code:30139-0471
Mailing Address - Country:US
Mailing Address - Phone:706-337-5541
Mailing Address - Fax:706-337-5461
Practice Address - Street 1:2688 HIGHWAY 411 SE
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT
Practice Address - State:GA
Practice Address - Zip Code:30139-2924
Practice Address - Country:US
Practice Address - Phone:706-337-5541
Practice Address - Fax:706-337-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00375845AMedicaid
3979680001Medicare ID - Type Unspecified
GA00375845AMedicaid