Provider Demographics
NPI:1033158258
Name:NUTT, SUZANNE HAMILTON (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:HAMILTON
Last Name:NUTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 REMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4725
Mailing Address - Country:US
Mailing Address - Phone:704-671-7483
Mailing Address - Fax:704-671-5331
Practice Address - Street 1:2240 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4725
Practice Address - Country:US
Practice Address - Phone:704-671-7483
Practice Address - Fax:704-671-5331
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93-002592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8963430Medicaid
NC8963430Medicaid
NCF75141Medicare UPIN