Provider Demographics
NPI:1659497907
Name:TOOTLE, JERRY CURTIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:CURTIS
Last Name:TOOTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 GADSEN WALK
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4351
Mailing Address - Country:US
Mailing Address - Phone:678-473-4884
Mailing Address - Fax:
Practice Address - Street 1:2655 GADSEN WALK
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4351
Practice Address - Country:US
Practice Address - Phone:678-473-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12584208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery