Healthcare Provider Details

I. General information

NPI: 1730932047
Provider Name (Legal Business Name): MRS. CRYSTAL HUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DUNWOODY PARK STE 220
ATLANTA GA
30338-7404
US

IV. Provider business mailing address

1038 BOSEMAN DR
LITHIA SPRINGS GA
30122-3962
US

V. Phone/Fax

Practice location:
  • Phone: 470-702-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: