Individual
CHUCK ANDREW JETTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 JOHNSON FY RD NE, ATLANTA, GA 30342-1606
(404) 851-8000
Mailing address
1000 JOHNSON FY RD NE, ATLANTA, GA 30342-1606
(404) 851-8000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
72792
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009995905
—
AL
05
—
009995915
—
AL
05
—
009995925
—
AL
01
—
010033CI29987
SECTION 1011
AL
01
—
01326791
MISSISSIPPI MEDICAID
MS
01
—
051528337
BLUE CROSS
AL
01
—
051528338
BLUE CROSS
AL
01
—
051528339
BLUE CROSS
AL
Enumeration date
06/26/2006
Last updated
12/15/2021
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