Provider Demographics
NPI:1740481381
Name:KUTZER, JARED CHARLES (AA)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:CHARLES
Last Name:KUTZER
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2195 MURRAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2610
Mailing Address - Country:US
Mailing Address - Phone:216-225-5394
Mailing Address - Fax:
Practice Address - Street 1:405 ARROWHEAD BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1254
Practice Address - Country:US
Practice Address - Phone:770-478-9877
Practice Address - Fax:770-478-2908
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1557367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA649695891BMedicaid