Provider Demographics
NPI:1871881532
Name:TENNYSON, WALTER G (RPH)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:G
Last Name:TENNYSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1799 BRIARCLIFF RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2142
Mailing Address - Country:US
Mailing Address - Phone:404-873-3438
Mailing Address - Fax:404-875-1681
Practice Address - Street 1:1799 BRIARCLIFF RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-2142
Practice Address - Country:US
Practice Address - Phone:404-873-3438
Practice Address - Fax:404-875-1681
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA9529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist