Provider Demographics
NPI:1124093273
Name:CUTSURIES, ANTHONY M (DPM)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:CUTSURIES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE STE 900
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3084
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:500 MEDICAL CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3330
Practice Address - Country:US
Practice Address - Phone:770-822-2166
Practice Address - Fax:770-237-2934
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000739213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2600025OtherUNITED HEALTHCARE
GA2701691OtherEVERCARE
GA2701691OtherEVERCARE
GAU28814Medicare UPIN
GA1103400008Medicare NSC
GA48SCBVGMedicare PIN
GA480023603Medicare PIN