Provider Demographics
NPI:1962005488
Name:SHATTO, THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SHATTO
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 1:1100 BARNETT SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-2710
Mailing Address - Country:US
Mailing Address - Phone:404-538-8452
Mailing Address - Fax:
Practice Address - Street 1:4183 HIGHWAY 278 NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2400
Practice Address - Country:US
Practice Address - Phone:770-385-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist