Provider Demographics
NPI:1821052077
Name:HUTCHINSON, AMY KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:KATHLEEN
Last Name:HUTCHINSON
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 1:1365B CLIFTON RD NE
Mailing Address - Street 2:ROOM 4513
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-5292
Mailing Address - Fax:404-778-5309
Practice Address - Street 1:1365B CLIFTON RD NE
Practice Address - Street 2:ROOM 4513
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-5292
Practice Address - Fax:404-778-5309
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036185207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000771097AMedicaid
GAG46947001Medicare UPIN
GA18BDGCWMedicare ID - Type Unspecified