Provider Demographics
NPI:1114207164
Name:HUTTON, MARY D (LMT, NCTM)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:D
Last Name:HUTTON
Suffix:
Gender:F
Credentials:LMT, NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 REGISTRY TER NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2855
Mailing Address - Country:US
Mailing Address - Phone:770-429-0208
Mailing Address - Fax:404-745-0707
Practice Address - Street 1:825 REGISTRY TER NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-2855
Practice Address - Country:US
Practice Address - Phone:770-429-0208
Practice Address - Fax:404-745-0707
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001419174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist