Provider Demographics
NPI:1215604970
Name:BUTTS, CATHY ANN
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:ANN
Last Name:BUTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:FUNSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31753-0193
Mailing Address - Country:US
Mailing Address - Phone:229-529-6560
Mailing Address - Fax:
Practice Address - Street 1:127 S MANNING ST
Practice Address - Street 2:
Practice Address - City:FUNSTON
Practice Address - State:GA
Practice Address - Zip Code:31753
Practice Address - Country:US
Practice Address - Phone:229-529-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver