Organization
ADVANCED MEDICAL GROUP, LLC
Active
Other names
Thomas Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
VANCE WALL RPH (CEO)
(678) 689-2388
Entity
Organization
Contact information
Practice address
816 GORDON AVE, THOMASVILLE, GA 31792-6611
(229) 226-4201
(229) 226-4206
Mailing address
PO BOX 1860, LANGLEY, SC 29834-1860
(803) 593-3411
(678) 689-1459
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
000001
GA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000037045A
—
GA
01
—
2134358
PK
—
Enumeration date
07/10/2006
Last updated
04/26/2017
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