# LONGS DRUGS OF SANDERSVILLE GEORGIA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avita Pharmacy 1046
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053357509
- **Authorized official:** CARL CODY COLQUITT (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (469) 592-2011

## Contact information

- **Practice address:** 2140 PEACHTREE RD NW, SUITE 232, ATLANTA, GA 30309-1316
- **Practice address phone:** (404) 231-4431
- **Practice address fax:** (404) 231-5677
- **Mailing address:** 5700 GRANITE PARKWAY, SUITE 425, PLANO, TX 75024-6648
- **Mailing address phone:** (469) 592-2011
- **Mailing address fax:** (404) 231-5677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0002X | Clinic Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE009702 | GA | Yes |

## Other

- **Enumeration date:** 06/22/2006
- **Last updated:** 09/12/2025