Healthcare Provider Details

I. General information

NPI: 1366472672
Provider Name (Legal Business Name): ROSALIE KAYE SHULTZ BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

IV. Provider business mailing address

1535 HARBOUR OAKS RD
TUCKER GA
30084-7954
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax: 404-417-2961
Mailing address:
  • Phone: 770-934-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN065500
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: