Provider Demographics
NPI:1720544398
Name:KUTTEH, CAROL COUNTRYMAN (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:COUNTRYMAN
Last Name:KUTTEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 GLENDA RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-6702
Mailing Address - Country:US
Mailing Address - Phone:901-752-5524
Mailing Address - Fax:901-747-4446
Practice Address - Street 1:9250 GLENDA RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-6702
Practice Address - Country:US
Practice Address - Phone:901-752-5524
Practice Address - Fax:901-747-4446
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14353207V00000X
TXJ0982207V00000X
TN27764207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology