Provider Demographics
NPI:1770063786
Name:STUART, SUTTON
Entity type:Individual
Prefix:
First Name:SUTTON
Middle Name:
Last Name:STUART
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 1:28866 GA HIGHWAY 62
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:39813-9121
Mailing Address - Country:US
Mailing Address - Phone:229-359-0139
Mailing Address - Fax:
Practice Address - Street 1:28866 GA HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:GA
Practice Address - Zip Code:39813-9121
Practice Address - Country:US
Practice Address - Phone:229-359-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0588918282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer