Provider Demographics
NPI:1083672711
Name:KUTTAPPAN, MUTHU (MD)
Entity Type:Individual
Prefix:DR
First Name:MUTHU
Middle Name:
Last Name:KUTTAPPAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LEELA
Other - Middle Name:
Other - Last Name:KUTTAPPAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14779 BROWN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-4127
Mailing Address - Country:US
Mailing Address - Phone:770-788-7777
Mailing Address - Fax:770-788-7007
Practice Address - Street 1:14779 BROWN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4127
Practice Address - Country:US
Practice Address - Phone:770-788-7777
Practice Address - Fax:770-788-7007
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00607967CMedicaid
GA037851OtherLICENCE
GA037851OtherLICENCE
GA11BDNNSMedicare PIN