Healthcare Provider Details

I. General information

NPI: 1427627124
Provider Name (Legal Business Name): DUSTI WINTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 BEAVER RUIN RD STE 500
NORCROSS GA
30093-2813
US

IV. Provider business mailing address

12735 GRAN BAY PKWY W STE 204
JACKSONVILLE FL
32258-4499
US

V. Phone/Fax

Practice location:
  • Phone: 678-961-9933
  • Fax:
Mailing address:
  • Phone: 904-352-5710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-81190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: