GARY M DUTKA (NPI# 1902871445) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1902871445 |
Entity Type | Individual |
Full Name | GARY M DUTKA |
Credential | PA-C |
Practice Address |
2000 Dan Proctor Dr Saint Marys GA 31558-3810 |
Mailing Address |
Po Box 15385 Durham NC 27704-0385 |
Practice Telephone | 9124667000 |
Practice Fax Number | 9194775470 |
Mailing Telephone | 9194775152 |
Mailing Fax Number | 9194775474 |
Enumeration Date | 2006-02-20 |
Last Update Date | 2008-08-06 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
004291 | GA | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
GA | 256737965A | 05 | |
GA | AMERIGROUP | 01157750 | 01 |
GA | 256737965D | 05 | |
GA | 256737965C | 05 |
Street Address |
2000 DAN PROCTOR DR |
City | SAINT MARYS |
State | GA |
Zip Code | 31558-3810 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1497720023 | Jess M Martinez | Specialist | 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 2006-02-17 |
1750775128 | Imaging Associates of Georgia LLC | Radiology | 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 2015-03-24 |
1427452002 | Matthew Nesmith | Nurse Anesthetist, Certified Registered | 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 2014-10-10 |
1295136620 | Joshua Smith | Nurse Anesthetist, Certified Registered | 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 2014-09-04 |
1467865162 | Jasmina Ellis | Anesthesiologist Assistant | 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 2014-06-10 |
1689091381 | Laura M Estes | Nurse Anesthetist, Certified Registered | 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 2014-03-20 |
1346580586 | Prodocs LLC | Radiology | 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 2013-02-25 |
1144573700 | Jordan O'banion Caglayan | Anesthesiologist Assistant | 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 2012-10-19 |
1427383652 | Erin E Borowski | Anesthesiologist Assistant | 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 2009-10-06 |
1144555384 | Braden Elizabeth Burleson | Anesthesiologist Assistant | 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 2009-10-06 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942827332 | Primary Care of Coastal Georgia | Clinic/Center | 214a Professional Cir, St Marys, GA 31558 | 2020-07-01 |
1922659192 | Christian Bianca Booker | Social Worker | 944 Kings Bay Rd. #247, St. Marys, GA 31558 | 2019-09-27 |
1154897296 | Shonta Harper | Counselor | 708 Osborne St Ste 104, Saint Marys, GA 31558 | 2018-10-16 |
1174038095 | Camden Behavioral Wellness, Inc | Counselor | 605 Osborne Street, Saint Mary's, GA 31558 | 2017-12-14 |
1285149427 | Urgent Care of Coastal Georgia | General Practice | 214 A Professional Circle, St. Marys, GA 31558 | 2017-12-11 |
1679975783 | Jeremy Cole | Behavioral Analyst | 921 Charlie Smith Sr. Highway, St. Marys, GA 31558 | 2014-09-19 |
1053660738 | Janice Paulino Ramirez | Nurse Practitioner | 2040 Dan Proctor Drive, Suite 170, St Marys, GA 31558 | 2012-09-10 |
1174899454 | Light Horse Healthcare Inc | Voluntary or Charitable | 2060 Dan Proctor Drive, Suite 3300, St Marys, GA 31558 | 2012-03-30 |
1316215775 | Annette O. Perry | Counselor | 4019 Hwy 40 East, St. Marys, GA 31558 | 2011-12-13 |
1932486271 | Sarah Jo Meyers | Speech-Language Pathologist | 2015 Osborne Rd, Unit A, St Marys, GA 31558 | 2011-11-15 |
Find all providers in zip 31558 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1063601839 | Patrick Davidson | Physician Assistant | 314 Millers Branch Dr, Saint Marys, GA 31558-4164 | 2007-10-17 |
1407858277 | Anne M Breindel | Physician Assistant | 761 Johnsonburg Rd, Suite 240, Saint Marys, PA 15857-3483 | 2005-08-11 |
1043794456 | Kristina Marie Torretti | Physician Assistant | 761 Johnsonburg Rd, Saint Marys, PA 15857-3483 | 2018-09-20 |
1841740073 | Alexandra Julia Housler | Physician Assistant | 177 Washington St, Saint Marys, PA 15857-1349 | 2016-10-12 |
1366822546 | Erin E Williams | Physician Assistant | 761 Johnsonburg Rd, Saint Marys, PA 15857-3483 | 2015-06-03 |
1952715914 | Francesca Woelfel | Physician Assistant | 761 Johnsonburg Rd, Suite 240, Saint Marys, PA 15857-3483 | 2014-06-18 |
1518241157 | Rebecca Jane Rocco | Physician Assistant | 761 Johnsonburg Rd, Saint Marys, PA 15857-3483 | 2011-09-30 |
1659440493 | Samuel Taylor | Physician Assistant | 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810 | 2006-11-07 |
1518077999 | Paul S Clemens Sr. | Physician Assistant | 177 Washington St, Saint Marys, PA 15857-1349 | 2006-08-30 |
1982679064 | Frank David Clements | Physician Assistant | 2060 Dan Proctor Dr, Saint Marys, GA 31558-3894 | 2006-02-22 |
Find all providers in SAINT MARYS |
City | SAINT MARYS |
Zip Code | 31558 |
Please comment or provide details below to improve the information on GARY M DUTKA.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.