Provider Demographics
NPI:1730862871
Name:WATKINS, TRISTAN CARTER (PHARMD)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:CARTER
Last Name:WATKINS
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 1:1649 FERNSTONE DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-3572
Mailing Address - Country:US
Mailing Address - Phone:912-704-9110
Mailing Address - Fax:
Practice Address - Street 1:80 SEVEN HILLS BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-0574
Practice Address - Country:US
Practice Address - Phone:770-975-6786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist