Healthcare Provider Details

I. General information

NPI: 1134257686
Provider Name (Legal Business Name): DENISE COULTES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 EXECUTIVE PARK SOUTH NE SUITE 2090
ATLANTA GA
30329-2208
US

IV. Provider business mailing address

59 EXECUTIVE PARK SOUTH NE SUITE 2090
ATLANTA GA
30329-2208
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6296
  • Fax: 404-778-7208
Mailing address:
  • Phone: 404-778-6296
  • Fax: 404-778-7208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN126619NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: