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Individual

JASON LAMAR CUNNINGHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
703 N VETERANS BLVD, GLENNVILLE, GA 30427-2208
(912) 654-3031
(912) 654-1779
Mailing address
703 NORTH VETERANS BLVD, GLENNVILLE, GA 30427
(912) 654-3031
(912) 654-1779

Taxonomy

Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
380101061157017
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3801-0106-1157-017
CPHT CERT. #
GA
Enumeration date
02/02/2021
Last updated
08/24/2024
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