Individual
JESSE SUTHERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 INDUSTRIAL BLVD, DUBLIN, GA 31021-2981
(478) 274-3450
Mailing address
1823 BUCKEYE RD, EAST DUBLIN, GA 31027-2431
(478) 697-2244
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
41269
GA
163W00000X
Registered Nurse
Primary
RN22497
GA
Other
Enumeration date
08/11/2014
Last updated
08/11/2014
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