Healthcare Provider Details

I. General information

NPI: 1871259507
Provider Name (Legal Business Name): TEAM JULIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15830 WINTERFIELD WAY
MILTON GA
30004-8835
US

IV. Provider business mailing address

15830 WINTERFIELD WAY
MILTON GA
30004-8835
US

V. Phone/Fax

Practice location:
  • Phone: 404-668-5045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN J JULIAN
Title or Position: SOLE MBR
Credential:
Phone: 404-668-5045