Provider Demographics
NPI:1508825431
Name:HUTTON, CARL ANTHONY (PA)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:ANTHONY
Last Name:HUTTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 N POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:MT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2267
Mailing Address - Country:US
Mailing Address - Phone:336-786-4133
Mailing Address - Fax:336-786-4338
Practice Address - Street 1:280 N POINTE BLVD
Practice Address - Street 2:
Practice Address - City:MT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2267
Practice Address - Country:US
Practice Address - Phone:336-786-4133
Practice Address - Fax:336-786-4338
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P32869Medicare UPIN