Individual
DR. CARL BLAKE SOUTHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
935 GREEN ST NW, GAINESVILLE, GA 30501-3325
(770) 532-6253
(770) 532-6505
Mailing address
935 GREEN ST NW, GAINESVILLE, GA 30501-3325
(770) 532-6253
(770) 532-6505
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH029710
GA
Other
Enumeration date
12/30/2020
Last updated
12/30/2020
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