MEDICARE: JENNIFER M. TUTT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	41931	CO
2	207Q00000X	Family Medicine Physician	53382	GA

General Provider Information

NPI Number	:	1003866435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M. TUTT MD

Provider Business Mailing Address
First Line	:	755 MOUNT VERNON HWY NE STE 110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4276
Country	:	US
Telephone Number	:	404-419-4700
Fax Number	:	419-404-4702

Provider Business Practice Location Address
First Line	:	755 MOUNT VERNON HWY NE STE 110
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-4276
Country	:	US
Telephone Number	:	404-419-4700
Fax Number	:	404-419-4701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	08/03/2023

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