Provider Demographics
NPI:1639691181
Name:EVATT, DAVID RUSTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUSTIN
Last Name:EVATT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:RUSTIN
Other - Middle Name:
Other - Last Name:EVATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:128 LYNNVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-5756
Mailing Address - Country:US
Mailing Address - Phone:478-954-0781
Mailing Address - Fax:
Practice Address - Street 1:195 TOM HILL SR BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1816
Practice Address - Country:US
Practice Address - Phone:478-757-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist