Healthcare Provider Details

I. General information

NPI: 1740115575
Provider Name (Legal Business Name): JULIA STUBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12060 ETRIS RD STE F100
ROSWELL GA
30075-1470
US

IV. Provider business mailing address

12060 ETRIS RD STE F100
ROSWELL GA
30075-1470
US

V. Phone/Fax

Practice location:
  • Phone: 770-998-9599
  • Fax: 770-645-1313
Mailing address:
  • Phone: 770-998-9599
  • Fax: 770-645-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018343
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: