Healthcare Provider Details

I. General information

NPI: 1427756568
Provider Name (Legal Business Name): LAKITA RUSHING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6602 DEKEON DR
ATLANTA GA
30349-8862
US

IV. Provider business mailing address

6602 DEKEON DR
ATLANTA GA
30349-8862
US

V. Phone/Fax

Practice location:
  • Phone: 404-883-1575
  • Fax:
Mailing address:
  • Phone: 404-883-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: