GARY M DUTKA


Address: 2000 Dan Proctor Dr, Saint Marys, GA 31558-3810
Phone: 9124667000

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AM0700X Physician Assistant
Specialization: Medical
004291 GA Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
GA 256737965A 05
GA AMERIGROUP 01157750 01
GA 256737965D 05
GA 256737965C 05

Office Location

Street Address 2000 DAN PROCTOR DR
City SAINT MARYS
State GA
Zip Code 31558-3810

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

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
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Competitor

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City SAINT MARYS
Zip Code 31558

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Dataset Information

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.

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