Healthcare Provider Details

I. General information

NPI: 1184298051
Provider Name (Legal Business Name): KAREN T SHIRLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2021
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 MAIN ST STE 200
STONE MOUNTAIN GA
30083-3097
US

IV. Provider business mailing address

925 MAIN ST STE 200
STONE MOUNTAIN GA
30083-3097
US

V. Phone/Fax

Practice location:
  • Phone: 678-476-3775
  • Fax:
Mailing address:
  • Phone: 678-476-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number755675
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: