Healthcare Provider Details

I. General information

NPI: 1023224763
Provider Name (Legal Business Name): GWENDOLYN M TUTT D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 PADDLEWHEEL DR
MARIETTA GA
30062-3853
US

IV. Provider business mailing address

1714 PADDLEWHEEL DR
MARIETTA GA
30062-3853
US

V. Phone/Fax

Practice location:
  • Phone: 770-792-6100
  • Fax:
Mailing address:
  • Phone: 770-792-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIRO02346
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: