Provider Demographics
NPI:1598256364
Name:TULL, AUSTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:TULL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 HOLLY SPRINGS PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-9580
Mailing Address - Country:US
Mailing Address - Phone:770-704-6161
Mailing Address - Fax:770-704-6171
Practice Address - Street 1:2260 HOLLY SPRINGS PKWY STE 180
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9580
Practice Address - Country:US
Practice Address - Phone:770-704-6161
Practice Address - Fax:770-704-6171
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA41503291835P1300X
GA027151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric