# ADVANCED MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THOMAS DRUG STORE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679811731
- **Authorized official:** MR. VANCE T WALL SR. RPH (CEO/PRESIDENT)
- **Authorized official phone:** (877) 645-3506

## Contact information

- **Practice address:** 118 N MAIN ST, BOSTON, GA 31626-2257
- **Practice address phone:** (229) 498-1018
- **Practice address fax:** (229) 498-1012
- **Mailing address:** 450 OLD PEACHTREE RD NW, SUITE 102, SUWANEE, GA 30024-7289
- **Mailing address phone:** (877) 645-3506
- **Mailing address fax:** (678) 689-1459

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | PHRE009897 | GA | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE009897 | GA | Yes |

## Other

- **Enumeration date:** 01/24/2013
- **Last updated:** 01/29/2013