Provider Demographics
NPI:1164405304
Name:HUTSON, TERESA DIANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:DIANNE
Last Name:HUTSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:DIANNE
Other - Last Name:HESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 2585
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-2585
Mailing Address - Country:US
Mailing Address - Phone:706-660-8505
Mailing Address - Fax:706-660-9390
Practice Address - Street 1:865 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0210
Practice Address - Country:US
Practice Address - Phone:912-427-6811
Practice Address - Fax:706-660-9390
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN082039367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000558665CMedicaid
GA43ZCBCP05Medicare PIN
GA000558665CMedicaid
R74741Medicare UPIN