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Organization
LONGS DRUGS OF SANDERSVILLE GEORGIA INC
Active
Organization
LONGS DRUGS OF SANDERSVILLE GEORGIA INC
Active
Other names
Avita Pharmacy 1046
Organization subpart
No
Provider details
NPI number
Authorized official
CARL CODY COLQUITT (CHIEF FINANCIAL OFFICER)
(469) 592-2011
Entity
Organization
Contact information
Practice address
2140 PEACHTREE RD NW, SUITE 232, ATLANTA, GA 30309-1316
(404) 231-4431
(404) 231-5677
Mailing address
5700 GRANITE PARKWAY, SUITE 425, PLANO, TX 75024-6648
(469) 592-2011
(404) 231-5677
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0002X
Clinic Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009702
GA
Other
Enumeration date
06/22/2006
Last updated
09/12/2025
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