Organization
ATHENS CUSTOM MEDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY SEAGRAVES PHARMD (PIC)
(706) 433-0246
Entity
Organization
Contact information
Practice address
810A HAWTHORNE AVE, ATHENS, GA 30606-2116
(706) 433-0246
Mailing address
810A HAWTHORNE AVE, ATHENS, GA 30606-2116
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHHH000015
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1153915
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/08/2006
Last updated
09/11/2025
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