| Organization Name: | EAST GEORGIA PREVENTATIVE HEALTH SPECIALISTS, LLC |
| NPI Number: | 1790908622 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BOBBY DEAN STONE (OWNER) |
| Mailing Address: | 150 S Leroy St Ste A Metter |
| State: | GA US |
| Postal Code: | 304394631 |
| Phone Number: | 9126857498 |
| Fax Number: | 9126853777 |
| NPI Enumeration Date: | 04/10/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | PHRE008829 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |