Healthcare Provider Details

I. General information

NPI: 1356268601
Provider Name (Legal Business Name): MARY GULLATTE, GULLATTE PHD, MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 BRANCH VIEW DR
MARIETTA GA
30062-1910
US

IV. Provider business mailing address

2040 BRANCH VIEW DR
MARIETTA GA
30062-1910
US

V. Phone/Fax

Practice location:
  • Phone: 404-831-1881
  • Fax:
Mailing address:
  • Phone: 404-831-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN054217
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: