Provider Demographics
NPI:1508825431
Name:HUTTON, CARL ANTHONY (PA)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:ANTHONY
Last Name:HUTTON
Suffix:
Gender:
Credentials:PA
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 1267
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-1267
Mailing Address - Country:US
Mailing Address - Phone:336-719-7112
Mailing Address - Fax:336-786-3752
Practice Address - Street 1:1016 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5330
Practice Address - Country:US
Practice Address - Phone:336-783-8900
Practice Address - Fax:336-783-3417
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103219363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P32869Medicare UPIN