Healthcare Provider Details

I. General information

NPI: 1568391209
Provider Name (Legal Business Name): MRS. COURTNEY NUTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 SUWANEE DAM RD
SUWANEE GA
30024-8701
US

IV. Provider business mailing address

8825 BAYHILL DR
GAINESVILLE GA
30506-8012
US

V. Phone/Fax

Practice location:
  • Phone: 770-283-8386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: