Provider Demographics
NPI:1194142513
Name:GUTERMUTH, AMY MARIE TURNER
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE TURNER
Last Name:GUTERMUTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 SW HARRISON ST
Mailing Address - Street 2:APT 2F
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5337
Mailing Address - Country:US
Mailing Address - Phone:404-538-4127
Mailing Address - Fax:
Practice Address - Street 1:242 KING AVENUE SUITE 120
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-475-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN221128367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife