Healthcare Provider Details

I. General information

NPI: 1962316349
Provider Name (Legal Business Name): ELIZABETH STULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 S BELAIR RD
MARTINEZ GA
30907-9601
US

IV. Provider business mailing address

432 S BELAIR RD
MARTINEZ GA
30907-9601
US

V. Phone/Fax

Practice location:
  • Phone: 706-817-4149
  • Fax:
Mailing address:
  • Phone: 706-817-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2856808
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: