Healthcare Provider Details

I. General information

NPI: 1053659953
Provider Name (Legal Business Name): BETH-ANN BUITEKANT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 CLAIRMONT RD
DECATUR GA
30030-1259
US

IV. Provider business mailing address

1244 CLAIRMONT RD
DECATUR GA
30030-1259
US

V. Phone/Fax

Practice location:
  • Phone: 404-818-6073
  • Fax:
Mailing address:
  • Phone: 404-818-6073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR065174
License Number StateGA

VIII. Authorized Official

Name: DR. BETH-ANN BUITEKANT
Title or Position: PRESIDENT
Credential: PSY. D., RN
Phone: 404-818-6073