Provider Demographics
NPI:1316083645
Name:JERRY E NUTT DDS & ASSOC OF DOUGLASVILLE
Entity type:Organization
Organization Name:JERRY E NUTT DDS & ASSOC OF DOUGLASVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-489-6735
Mailing Address - Street 1:8505 HOSPITAL DR
Mailing Address - Street 2:SUITE 7 & 8
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2414
Mailing Address - Country:US
Mailing Address - Phone:770-489-6735
Mailing Address - Fax:
Practice Address - Street 1:8505 HOSPITAL DR
Practice Address - Street 2:SUITE 7 & 8
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2414
Practice Address - Country:US
Practice Address - Phone:770-489-6735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty