Healthcare Provider Details

I. General information

NPI: 1104664192
Provider Name (Legal Business Name): COURTNEY HUTCHINSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CHEROKEE ST NE STE 300
MARIETTA GA
30060-7233
US

IV. Provider business mailing address

4150 UNION HILL RD
CANTON GA
30115-7143
US

V. Phone/Fax

Practice location:
  • Phone: 770-635-1812
  • Fax:
Mailing address:
  • Phone: 770-403-7905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: