Healthcare Provider Details

I. General information

NPI: 1598448730
Provider Name (Legal Business Name): MS. SEAIRRA HULBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 METROPOLITAN PKWY SW STE A
ATLANTA GA
30315-5926
US

IV. Provider business mailing address

2169 MIRIAM LN
DECATUR GA
30032-5553
US

V. Phone/Fax

Practice location:
  • Phone: 770-988-6978
  • Fax:
Mailing address:
  • Phone: 678-526-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCO136586
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: