Provider Demographics
NPI:1699141226
Name:ADDS PERSONAL CARE PHARMACY LLC
Entity type:Organization
Organization Name:ADDS PERSONAL CARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-726-2111
Mailing Address - Street 1:1020 GARLAND DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-3220
Mailing Address - Country:US
Mailing Address - Phone:678-726-2111
Mailing Address - Fax:678-726-2113
Practice Address - Street 1:1020 GARLAND DR STE 700
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-3222
Practice Address - Country:US
Practice Address - Phone:678-726-2111
Practice Address - Fax:678-726-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0101683336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154100OtherPK
GA003168046AMedicaid