Provider Demographics
NPI:1487793808
Name:JERRY E NUTT DDS, PC
Entity type:Organization
Organization Name:JERRY E NUTT DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-980-9860
Mailing Address - Street 1:1545 POWERS FERRY RD SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9412
Mailing Address - Country:US
Mailing Address - Phone:770-980-9860
Mailing Address - Fax:850-837-2042
Practice Address - Street 1:1545 POWERS FERRY RD SE
Practice Address - Street 2:SUITE B
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9412
Practice Address - Country:US
Practice Address - Phone:770-980-9860
Practice Address - Fax:850-837-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty