Individual
DANIEL SOUTHERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
192 1ST AVE, EAST ELLIJAY, GA 30540-8101
(706) 635-2241
Mailing address
192 1ST AVE, EAST ELLIJAY, GA 30540-8101
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH017796
GA
Other
Enumeration date
05/01/2017
Last updated
05/01/2017
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