Provider Demographics
NPI:1831618388
Name:SUTTON, AUTUMN NICOLE (RN,BSN,NP)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:NICOLE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:RN,BSN,NP
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:NICOLE
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2069 MILLER FERRY RD SW
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-3240
Mailing Address - Country:US
Mailing Address - Phone:770-877-1599
Mailing Address - Fax:
Practice Address - Street 1:1387 US 41 N
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1643
Practice Address - Country:US
Practice Address - Phone:770-877-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220328363LF0000X
GA27-4023059213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN220328OtherGEORGIA NURSING LICENSE