Jerry E Nutt DDS & Assoc of College Park

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

JERRY E NUTT DDS & ASSOC OF COLLEGE PARK

Practice address

1571 Phoenix Blvd
College Park, GA 30349-5536

Phone

(770) 996-7700

NPI assigned

Jan 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michelle Smith

Title

Office Manager

Phone

(770) 996-7700

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710023080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1571 PHOENIX BLVD",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495536",
            "telephone_number": "770-996-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1571 PHOENIX BLVD",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303495536",
            "telephone_number": "770-996-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY E NUTT DDS & ASSOC OF COLLEGE PARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-996-7700"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Miriam Jenkins, MSW
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• Keith Johnson
• Pamela Deshawn Johnson, LPC

• General Practice Dentistry in College Park, GA
• Providers in College Park, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.