| Olde Time Pharmacy At Sixes, Llc | |
|
684 Sixes Rd Suite 105 Holly Springs GA 30115-8721 | |
| (678) 445-4486 | |
| (678) 445-3536 |
| Full Name | Olde Time Pharmacy At Sixes, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 684 Sixes Rd, Holly Springs, Georgia |
| Authorized Official Name and Position | Shad Sutherland (MANAGER) |
| Authorized Official Contact | 6784454486 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Olde Time Pharmacy At Sixes, Llc 684 Sixes Rd Suite 105 Holly Springs GA 30115-8721 Ph: (678) 445-4486 | Olde Time Pharmacy At Sixes, Llc 684 Sixes Rd Suite 105 Holly Springs GA 30115-8721 Ph: (678) 445-4486 |
| NPI Number | 1831476316 |
|---|---|
| Provider Enumeration Date | 11/10/2011 |
| Last Update Date | 11/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831476316 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | PHRE009711 (Georgia) | Primary |
Revived Medical Spa Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 350 Hillgrove Dr, Holly Springs, GA 30114 Phone: 404-551-6686 |