Provider Demographics
NPI:1992157085
Name:AUSTIN, JIMMY BRYANT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:BRYANT
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:565 PEACHTREE ST NE STE B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2213
Mailing Address - Country:US
Mailing Address - Phone:404-662-3433
Mailing Address - Fax:404-662-3435
Practice Address - Street 1:25 PEACHTREE ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3140
Practice Address - Country:US
Practice Address - Phone:404-260-1038
Practice Address - Fax:404-260-1039
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist