Provider Demographics
NPI:1063380558
Name:WUTZ, JULIA PERRY
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:PERRY
Last Name:WUTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HILTON WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-6012
Mailing Address - Country:US
Mailing Address - Phone:678-923-3918
Mailing Address - Fax:
Practice Address - Street 1:4255 WADE GREEN RD NW STE 320
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1811
Practice Address - Country:US
Practice Address - Phone:770-423-1316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220003363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology