Provider Demographics
NPI:1447331442
Name:DJTR HOLDINGS, INC
Entity type:Organization
Organization Name:DJTR HOLDINGS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-435-4571
Mailing Address - Street 1:49 HARRELL ST
Mailing Address - Street 2:
Mailing Address - City:TRION
Mailing Address - State:GA
Mailing Address - Zip Code:30753
Mailing Address - Country:US
Mailing Address - Phone:706-734-2481
Mailing Address - Fax:706-734-7787
Practice Address - Street 1:49 HARRELL ST
Practice Address - Street 2:
Practice Address - City:TRION
Practice Address - State:GA
Practice Address - Zip Code:30753
Practice Address - Country:US
Practice Address - Phone:706-734-2481
Practice Address - Fax:706-734-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GA5818478443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00306369AMedicaid
GA00306369AMedicaid