Healthcare Provider Details

I. General information

NPI: 1467378844
Provider Name (Legal Business Name): RILEY L SHULL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5328 LANIER ISLANDS PKWY # 101
BUFORD GA
30518-9071
US

IV. Provider business mailing address

80 LAWRENCEVILLE SUWANEE RD APT 1516
LAWRENCEVILLE GA
30044-1108
US

V. Phone/Fax

Practice location:
  • Phone: 470-655-1970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: