Healthcare Provider Details

I. General information

NPI: 1740325125
Provider Name (Legal Business Name): DAVID WILLIAM KUGLIN L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 CONSTITUTION BLVD D
LAWRENCEVILLE GA
30046-5696
US

IV. Provider business mailing address

2990 FORBES TRL
SNELLVILLE GA
30039-5933
US

V. Phone/Fax

Practice location:
  • Phone: 770-722-8156
  • Fax:
Mailing address:
  • Phone: 770-722-8156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number916
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: