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
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009702
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003291812A
—
GA
01
—
1148279
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/22/2006
Last updated
09/12/2025
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