Provider Demographics
NPI:1972011054
Name:SUTTON, SAVANNA LOUISE
Entity Type:Individual
Prefix:
First Name:SAVANNA
Middle Name:LOUISE
Last Name:SUTTON
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 2
Mailing Address - Street 2:
Mailing Address - City:MARBLE
Mailing Address - State:NC
Mailing Address - Zip Code:28905-0002
Mailing Address - Country:US
Mailing Address - Phone:828-361-7370
Mailing Address - Fax:
Practice Address - Street 1:89 OLD SIDE TRACK ROAD
Practice Address - Street 2:
Practice Address - City:MARBLE
Practice Address - State:NC
Practice Address - Zip Code:28905-2890
Practice Address - Country:US
Practice Address - Phone:828-837-6798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer