Healthcare Provider Details

I. General information

NPI: 1578637864
Provider Name (Legal Business Name): CHANDILA YVETTE TUTT RN, CNS, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SYCAMORE STA
DECATUR GA
30030-2764
US

IV. Provider business mailing address

34 SYCAMORE STA
DECATUR GA
30030-2764
US

V. Phone/Fax

Practice location:
  • Phone: 404-276-9489
  • Fax:
Mailing address:
  • Phone: 404-276-9489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number116406
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberR116406
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR116406
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: