Healthcare Provider Details

I. General information

NPI: 1639030422
Provider Name (Legal Business Name): SYDNEY HOTALING LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MARIETTA HWY
CANTON GA
30114-2327
US

IV. Provider business mailing address

14 ASPEN DR NW
CARTERSVILLE GA
30120-4379
US

V. Phone/Fax

Practice location:
  • Phone: 770-789-3797
  • Fax:
Mailing address:
  • Phone: 770-712-9671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW012254
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: