Provider Demographics
NPI:1205551090
Name:WALCUTT, JOSEPH CALEB (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CALEB
Last Name:WALCUTT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 CHERRY ST APT 522
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1022
Mailing Address - Country:US
Mailing Address - Phone:904-234-6972
Mailing Address - Fax:
Practice Address - Street 1:500 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-2813
Practice Address - Country:US
Practice Address - Phone:904-630-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116798363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant