MEDICARE: JAMES A. STUTTS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN101112	GA

General Provider Information

NPI Number	:	1154333060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES A. STUTTS CRNA

Provider Business Mailing Address
First Line	:	11999 SAN VICENTE BLVD
Second Line	:	STE. 440
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5131
Country	:	US
Telephone Number	:	310-440-3131
Fax Number	:	310-472-9582

Provider Business Practice Location Address
First Line	:	2522 WARM SPRINGS RD
Second Line	:	STE. B
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5640
Country	:	US
Telephone Number	:	706-322-9313
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	04/18/2008

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