NPIMap

Individual provider Active NPI

Charles David Lutin, MD

  • Emergency Medicine Physician
  • Gainesville, GA
National Provider Identifier
1881640266
Registry record updated Jun 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
067061 Issued in GA
Practice address
597 S Enota Dr NE
Gainesville, GA 30501-2545
Phone
(770) 219-8206
Fax
(770) 219-7778
NPI assigned
May 26, 2006
Last updated
Jun 25, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 067061 GA Primary

Addresses

Primary practice location

597 S Enota Dr NE
Gainesville, GA 30501-2545

Mailing address

601 S Enota Dr NE
Suite Q
Gainesville, GA 30501-2400
Phone (770) 219-8206

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Physicians of Gaston County, PLLC Emergency Medicine Past Accepting new patients
Chase Dennis Emergency Medical Group Inc Emergency Medicine Past Accepting new patients
Wendy L Smith M.D. PC Past Accepting new patients
Phoenix Emergency Services of Murphy PLLC Emergency Medicine Past Accepting new patients
Carolinas Physicians Network Inc Family Medicine Past Accepting new patients
Ingenuity Medical Group LLC Emergency Medicine Past Accepting new patients
Phoenix Emergency Solutions of Fletcher PLLC Emergency Medicine Past Accepting new patients
Afc Physicians of Georgia Primary Care, PC Family Medicine Past Accepting new patients

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340582400000",
    "number": "1881640266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S ENOTA DR NE",
            "address_2": "SUITE Q",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012400",
            "telephone_number": "770-219-8206",
            "fax_number": "770-219-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "597 S ENOTA DR NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012545",
            "telephone_number": "770-219-8206",
            "fax_number": "770-219-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUTIN",
        "first_name": "CHARLES",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-26",
        "last_updated": "2012-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "067061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2012; 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.