Healthcare Provider Details

I. General information

NPI: 1619050077
Provider Name (Legal Business Name): ANGELA KAY HUTCHINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MAIN ST W
SNELLVILLE GA
30078-3157
US

IV. Provider business mailing address

3931 SAVANNAH RIDGE TRCE
LOGANVILLE GA
30052-2543
US

V. Phone/Fax

Practice location:
  • Phone: 770-979-2600
  • Fax: 770-736-0014
Mailing address:
  • Phone: 678-344-3131
  • Fax: 770-736-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number046130
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: