Provider Demographics
NPI:1962713099
Name:CASE, JIMMY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:CASE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 EALY RD
Mailing Address - Street 2:
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-2306
Mailing Address - Country:US
Mailing Address - Phone:423-386-5198
Mailing Address - Fax:
Practice Address - Street 1:1228 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4008
Practice Address - Country:US
Practice Address - Phone:706-861-7284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024241183500000X
TN32962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist