Provider Demographics
NPI:1861935199
Name:COMSTOCK, DUSTIN A
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:A
Last Name:COMSTOCK
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 1:968 MARBURY CT SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2989
Mailing Address - Country:US
Mailing Address - Phone:678-333-1206
Mailing Address - Fax:
Practice Address - Street 1:3964 N PEACHTREE RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1606
Practice Address - Country:US
Practice Address - Phone:404-237-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist