Healthcare Provider Details

I. General information

NPI: 1306079132
Provider Name (Legal Business Name): RICHARD WAYNE HULON M.DIV.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 JOHNS CREEK CT SUITE 240
SUWANEE GA
30024-1224
US

IV. Provider business mailing address

3905 JOHNS CREEK CT SUITE 240
SUWANEE GA
30024-1224
US

V. Phone/Fax

Practice location:
  • Phone: 770-540-0366
  • Fax: 770-886-2423
Mailing address:
  • Phone: 770-540-0366
  • Fax: 770-886-2423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC001752
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: