Provider Demographics
NPI:1841539566
Name:NUTT, ALFRED WALTER (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:WALTER
Last Name:NUTT
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:DR
Other - First Name:ALFRED
Other - Middle Name:WALTER
Other - Last Name:NUTT
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PHD, MD
Mailing Address - Street 1:4275 OWENS RD APT 125
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3064
Mailing Address - Country:US
Mailing Address - Phone:706-513-3921
Mailing Address - Fax:
Practice Address - Street 1:4275 OWENS RD APT 125
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3064
Practice Address - Country:US
Practice Address - Phone:706-513-3921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA27882208D00000X
SC12575208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice