Dutka, Gary M
Dutka, Gary M is an individual health care provider with primary practice located at 2000 Dan Proctor Dr , Saint Marys GA 31558-3810. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Dutka, Gary M can be contacted via phone (912) 466-7000.Contact Information
Primary practice address
2000 Dan Proctor Dr
Saint Marys GA 31558-3810
Phone: (912) 466-7000
Fax: (919) 477-5470
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 004291 | Georgia |
Profile Details
| NPI number | 1902871445 |
|---|---|
| LBN Legal business name | Dutka, Gary M |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 20th, 2006 |
| Last updated | Aug 6th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902871445 | NPPES |
| Georgia | MEDICAID | 256737965A | |
| Georgia | Other | 01157750 | |
| Georgia | MEDICAID | 256737965D | |
| Georgia | MEDICAID | 256737965C |
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