MEDICARE: DESTIN CHAILIE SUTTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	100266498	GA

General Provider Information

NPI Number	:	1740112002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTIN CHAILIE SUTTON

Provider Business Mailing Address
First Line	:	1350 HARDIN BRIDGE RD SW
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30120-5914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 HARDIN BRIDGE RD SW
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30120-5914
Country	:	US
Telephone Number	:	678-994-2312
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ DESTIN CHAILIE SUTTON ” Practice Location

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