Provider Demographics
NPI:1679171979
Name:DFG LLC
Entity type:Organization
Organization Name:DFG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-754-4128
Mailing Address - Street 1:638 HISTORIC HWY 441 SUITE A
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30530
Mailing Address - Country:US
Mailing Address - Phone:706-754-4128
Mailing Address - Fax:706-754-4928
Practice Address - Street 1:638 HISTORIC HWY 441 SUITE A
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30530
Practice Address - Country:US
Practice Address - Phone:706-754-4128
Practice Address - Fax:706-754-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA990894687AMedicaid