Healthcare Provider Details

I. General information

NPI: 1083411383
Provider Name (Legal Business Name): KIRSTEN HULSEY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 NORTHEAST EXPY NE STE 110
ATLANTA GA
30341-5323
US

IV. Provider business mailing address

3190 NORTHEAST EXPY NE STE 110
ATLANTA GA
30341-5323
US

V. Phone/Fax

Practice location:
  • Phone: 404-487-6005
  • Fax:
Mailing address:
  • Phone: 404-487-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-337186
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: