Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIRO02346 | GA |
NPI | 1023224763 |
---|---|
Provider Name | Dr. Gwendolyn M Tutt |
First Address | Marietta, GA 30062-3853 |
Second Address | Marietta, GA 30062-3853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |