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NPI Code Detail

MEDICARE: GAVRIELLA JUTAN

MEDICARE: GAVRIELLA JUTAN
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
1170300000XGenetic Counselor (M.S.)

General Provider Information

NPI Number : 1457286890
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAVRIELLA JUTAN
Provider Business Mailing Address
First Line : 1131 HOUSTON MILL ROAD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1131 HOUSTON MILL ROAD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329
Country : US
Telephone Number : 404-376-2366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2026
Last Update Date : 06/16/2026

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Directions to “ GAVRIELLA JUTAN ” Practice Location

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