Provider Demographics
NPI:1083765937
Name:CUTRONA, PAULA LORENE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:LORENE
Last Name:CUTRONA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:LORENE
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1505 STONEBRIDGE PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8282
Mailing Address - Country:US
Mailing Address - Phone:770-423-0595
Mailing Address - Fax:678-391-5093
Practice Address - Street 1:61 WHITCHER STREET NE
Practice Address - Street 2:SUITE 2100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1179
Practice Address - Country:US
Practice Address - Phone:770-423-0595
Practice Address - Fax:678-391-5093
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004664363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA105689292AMedicaid
GA97WCHJHMedicare ID - Type Unspecified
GA105689292AMedicaid