Healthcare Provider Details

I. General information

NPI: 1295985273
Provider Name (Legal Business Name): JULIA TYE HUTT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA TYE VASSAR CRNP

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FITNESS WAY STE. 1200
ATHENS AL
35611-2492
US

IV. Provider business mailing address

101 FITNESS WAY STE. 1200
ATHENS AL
35611-2492
US

V. Phone/Fax

Practice location:
  • Phone: 256-232-0636
  • Fax: 256-232-1281
Mailing address:
  • Phone: 256-232-0636
  • Fax: 256-232-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.20182
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-081164
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: