Healthcare Provider Details

I. General information

NPI: 1407782121
Provider Name (Legal Business Name): DESTINY OTTINOT RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

1654 OAK TRACE CIR
GRAYSON GA
30017-4011
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-5000
  • Fax:
Mailing address:
  • Phone: 770-527-8130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN286441
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: