Provider Demographics
NPI:1013597145
Name:BUTLER, JUSTIN SEAN (MD, SA-C)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:SEAN
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PHARR RD NE APT 1307
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2278
Mailing Address - Country:US
Mailing Address - Phone:864-354-1323
Mailing Address - Fax:
Practice Address - Street 1:250 PHARR RD NE APT 1307
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2278
Practice Address - Country:US
Practice Address - Phone:864-354-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
21-139246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant