Healthcare Provider Details

I. General information

NPI: 1083541387
Provider Name (Legal Business Name): DARIUS SHIRLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 FIVE FORKS TRICKUM RD SW STE AND203
LILBURN GA
30047-1890
US

IV. Provider business mailing address

500 WILLIAMS DR APT 517
MARIETTA GA
30066-6129
US

V. Phone/Fax

Practice location:
  • Phone: 470-485-2220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: