Healthcare Provider Details

I. General information

NPI: 1922493022
Provider Name (Legal Business Name): SPENCER KRISTIAN HUTTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DOWMAN DR NE
ATLANTA GA
30322-1007
US

IV. Provider business mailing address

201 DOWMAN DR NE
ATLANTA GA
30322-1007
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-6123
  • Fax:
Mailing address:
  • Phone: 404-727-6123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number83993
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: