Provider Demographics
NPI:1093717688
Name:SUTTON, ANDREW EVERETT (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:EVERETT
Last Name:SUTTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:780 CANTON RD NE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7241
Mailing Address - Country:US
Mailing Address - Phone:770-427-0368
Mailing Address - Fax:678-581-5969
Practice Address - Street 1:780 CANTON RD NE
Practice Address - Street 2:SUITE 330
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7241
Practice Address - Country:US
Practice Address - Phone:770-427-0368
Practice Address - Fax:678-581-5969
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA36884207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00553385CMedicaid
GA00553385CMedicaid
GAGRP4034Medicare PIN
GA04BDCGQMedicare PIN