Provider Demographics
NPI:1902172315
Name:LEDBETTER, DAVID J (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:LEDBETTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1659
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-0028
Mailing Address - Country:US
Mailing Address - Phone:706-754-3763
Mailing Address - Fax:706-839-1293
Practice Address - Street 1:596 W LOUISE ST
Practice Address - Street 2:SUITE D
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-5849
Practice Address - Country:US
Practice Address - Phone:706-754-3763
Practice Address - Fax:706-839-1293
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist