Healthcare Provider Details

I. General information

NPI: 1740100270
Provider Name (Legal Business Name): DECAROL GULLIFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 MARTIN LUTHER KING JR DR SW
ATLANTA GA
30311-1715
US

IV. Provider business mailing address

169 PEARTREE TER
RIVERDALE GA
30274-4483
US

V. Phone/Fax

Practice location:
  • Phone: 404-699-7774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: