Provider Demographics
NPI:1588978126
Name:SEAGRAVES, GREGORY BRIAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BRIAN
Last Name:SEAGRAVES
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CLEVELAND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-1701
Mailing Address - Country:US
Mailing Address - Phone:706-369-9591
Mailing Address - Fax:706-369-9698
Practice Address - Street 1:150 CLEVELAND RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-1701
Practice Address - Country:US
Practice Address - Phone:706-369-9591
Practice Address - Fax:706-369-9698
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist