Healthcare Provider Details

I. General information

NPI: 1598226664
Provider Name (Legal Business Name): KRISTIN D FAUNTLEROY-LOVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

2174 N DRUID HILLS RD NE
ATLANTA GA
30329-3102
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-4034
  • Fax: 317-944-1476
Mailing address:
  • Phone: 404-785-5437
  • Fax: 404-785-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number104458
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: