Individual
GARY M DUTKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2000 DAN PROCTOR DR, SAINT MARYS, GA 31558-3810
(912) 466-7000
(919) 477-5470
Mailing address
PO BOX 15385, DURHAM, NC 27704-0385
(919) 477-5152
(919) 477-5474
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004291
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01157750
AMERIGROUP
GA
05
—
256737965A
—
GA
05
—
256737965C
—
GA
05
—
256737965D
—
GA
Enumeration date
02/20/2006
Last updated
08/06/2008
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