Basic Information
| Provider Information | |||||||||
| NPI: | 1174070981 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCWHORTER | ||||||||
| FirstName: | TABITHA | ||||||||
| MiddleName: | WISHARD | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1498 KLONDIKE RD SW | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300945169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707617260 | ||||||||
| FaxNumber: | 6784131818 | ||||||||
| Practice Location | |||||||||
| Address1: | 1498 KLONDIKE RD SW | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300945169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707617260 | ||||||||
| FaxNumber: | 6784131818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2016 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835X0200X | RPH027868 | GA | Y | Pharmacy Service Providers | Pharmacist | Oncology |
No ID Information.