Healthcare Provider Details

I. General information

NPI: 1831247501
Provider Name (Legal Business Name): JAIME DRUMMOND KUTTER PA-C, MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400B OLD MILTON PKWY
ALPHARETTA GA
30005
US

IV. Provider business mailing address

6955 LANCASTER CIR
CUMMING GA
30040-7340
US

V. Phone/Fax

Practice location:
  • Phone: 770-442-1413
  • Fax:
Mailing address:
  • Phone: 770-205-8285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3780
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: