Provider Demographics
NPI:1285246462
Name:SHUTTER, WALTER WON
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:WON
Last Name:SHUTTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 FLOWERS RD STE 530
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-3195
Mailing Address - Country:US
Mailing Address - Phone:404-585-7517
Mailing Address - Fax:404-900-9209
Practice Address - Street 1:1447 PEACHTREE ST NE STE 206
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3018
Practice Address - Country:US
Practice Address - Phone:770-727-0443
Practice Address - Fax:404-900-9209
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist