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Individual

VIVIAN M HUTTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1551 DOCTORS DR, BUILDING 200, LAGRANGE, GA 30240-4139
(706) 884-2641
(706) 884-2353
Mailing address
1551 DOCTORS DR, BUILDING 200, LAGRANGE, GA 30240-4139
(706) 884-2641
(706) 884-2353

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002475
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100000064A
GA
Enumeration date
09/14/2005
Last updated
11/05/2019
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