Basic Information
| Provider Information | |||||||||
| NPI: | 1376502567 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUTTON | ||||||||
| FirstName: | ARNOLD | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 740209 | ||||||||
| Address2: | DEPT 1029 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303740209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413601566 | ||||||||
| FaxNumber: | 9413589818 | ||||||||
| Practice Location | |||||||||
| Address1: | 3079 PEACHTREE INDUSTRIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300972215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709455330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 11/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 31335 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 000459401 | 05 | GA | MEDICAID |