Healthcare Provider Details

I. General information

NPI: 1184416836
Provider Name (Legal Business Name): MAKIYA GUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 MABLETON PKWY SE UNIT 1101
MABLETON GA
30126-6021
US

IV. Provider business mailing address

6850 MABLETON PKWY SE UNIT 1101
MABLETON GA
30126-6021
US

V. Phone/Fax

Practice location:
  • Phone: 678-251-8818
  • Fax:
Mailing address:
  • Phone: 678-251-8818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: