Healthcare Provider Details

I. General information

NPI: 1417852401
Provider Name (Legal Business Name): MS. AVILLA TULL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 BROOK CIR
GRIFFIN GA
30224-4413
US

IV. Provider business mailing address

654 BROOK CIR
GRIFFIN GA
30224-4413
US

V. Phone/Fax

Practice location:
  • Phone: 770-713-1828
  • Fax: 225-470-1114
Mailing address:
  • Phone: 770-713-1828
  • Fax: 225-470-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: