Provider Demographics
NPI:1831247501
Name:KUTTER, JAIME DRUMMOND (PA-C, MPAS)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:DRUMMOND
Last Name:KUTTER
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 LANCASTER CIR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-7340
Mailing Address - Country:US
Mailing Address - Phone:770-205-8285
Mailing Address - Fax:
Practice Address - Street 1:3400B OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-442-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3780363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1050675OtherNCCPA CERTIFICATE NUMBER
GA3780OtherSTATE LICENSE