Basic Information
| Provider Information | |||||||||
| NPI: | 1578609780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCUTCHEN | ||||||||
| FirstName: | AJA | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SMITH | ||||||||
| OtherFirstName: | AJA | ||||||||
| OtherMiddleName: | SHARAH | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 550 PEACHTREE ST NE | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303082208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048887575 | ||||||||
| FaxNumber: | 4042536896 | ||||||||
| Practice Location | |||||||||
| Address1: | 299 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | WINDER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306802155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789871480 | ||||||||
| FaxNumber: | 6789871481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 05/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 058645 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 058645 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.