Provider Demographics
NPI:1912889312
Name:BUTTS, NATHANIEL (NREMT, PARAMEDIC)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:BUTTS
Suffix:
Gender:M
Credentials:NREMT, PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 ALTAMAHA WAY
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-2511
Mailing Address - Country:US
Mailing Address - Phone:765-412-0630
Mailing Address - Fax:
Practice Address - Street 1:512 ALTAMAHA WAY
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-2511
Practice Address - Country:US
Practice Address - Phone:765-412-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA24-3450146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic