Healthcare Provider Details

I. General information

NPI: 1922026806
Provider Name (Legal Business Name): THERON L HUTTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4696 NASHVILLE HWY
CHAPEL HILL TN
37034-2110
US

IV. Provider business mailing address

854 W JAMES CAMPBELL BLVD SUITE 303
COLUMBIA TN
38401-4659
US

V. Phone/Fax

Practice location:
  • Phone: 931-364-5090
  • Fax: 931-364-5091
Mailing address:
  • Phone: 931-364-5090
  • Fax: 931-364-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036114648
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49541
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: