Doctor Name: | DR. ALFRED WALTER NUTT |
NPI Number: | 1841539566 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D., M.D. |
License Number: | 12575 |
Business Practice Address: | 4275 Owens Rd Apt 125 Evans, GA - 308093064 |
Business Phone Number: | 7065133921 |
Business Fax Number: | |
Mailing Address: | 4275 Owens Rd Apt 125, EVANS |
State: | GA |
Postal Code: | 308093064 |
Phone Number: | 7065133921 |
Fax Number: | |
NPI Enumeration Date: | 02/01/2013 |
NPI Last Update Date: | 05/03/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 12575 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | SC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |