Active NPI
Walter Won Shutter
- Pharmacist
- Atlanta, GA
National Provider Identifier
1285246462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH028664
- Practice address
- 1447 Peachtree St NE Ste 206
Atlanta, GA 30309-3018 - Phone
- (770) 727-0443
- Fax
- (404) 900-9209
- NPI assigned
- Aug 19, 2020
- Last updated
- Mar 15, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH028664 | GA | Primary |
Addresses
Primary practice location
1447 Peachtree St NE Ste 206
Atlanta, GA 30309-3018
Mailing address
3990 Flowers Rd Ste 530
Atlanta, GA 30360-3195
Phone (404) 585-7517
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH028664 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Synergen RX LLC | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Synergen RX LLC | Past | Accepting new patients |
Locations
1447 Peachtree St NE
Ste 206
Atlanta, GA 30309
Phone (770) 727-0443
3990 Flowers Rd
Ste 530
Doraville, GA 30360
Phone (404) 585-7517
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678838400000",
"number": "1285246462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3990 FLOWERS RD STE 530",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303603195",
"telephone_number": "404-585-7517",
"fax_number": "404-900-9209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1447 PEACHTREE ST NE STE 206",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303093018",
"telephone_number": "770-727-0443",
"fax_number": "404-900-9209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUTTER",
"first_name": "WALTER",
"middle_name": "WON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-19",
"last_updated": "2023-03-15",
"certification_date": "2023-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH028664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.