Provider Demographics
NPI:1851551188
Name:OTT, NATHAN JOHN (PHARMD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JOHN
Last Name:OTT
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 1:1308 W WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3827
Mailing Address - Country:US
Mailing Address - Phone:706-270-5884
Mailing Address - Fax:706-270-9795
Practice Address - Street 1:1308 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3827
Practice Address - Country:US
Practice Address - Phone:706-270-5884
Practice Address - Fax:706-270-9795
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist