Healthcare Provider Details

I. General information

NPI: 1366367591
Provider Name (Legal Business Name): JULIE DESIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 KINGSTON CT SE STE E
MARIETTA GA
30067-8952
US

IV. Provider business mailing address

6255 RIVER VIEW RD SE
MABLETON GA
30126-3034
US

V. Phone/Fax

Practice location:
  • Phone: 678-304-8215
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMSW012776
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: