Provider Demographics
NPI:1174341184
Name:BUTGEREIT, JOHN DOUGLAS
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DOUGLAS
Last Name:BUTGEREIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LAGUNA SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3039
Mailing Address - Country:US
Mailing Address - Phone:404-977-9147
Mailing Address - Fax:
Practice Address - Street 1:3051 SANDY PLAINS RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4721
Practice Address - Country:US
Practice Address - Phone:770-977-7661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH035126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist