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General NPI Number Information
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NPI Number | 1235718842
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Entity Type | Individual
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Provider Name | JULIE SUTTLES TATE LMSW
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Gender | Female
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 431 GREEN ST NW
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City | GAINESVILLE
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State | GA
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Zip | 30501-3349
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Country | US
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Telephone | 470-460-5582
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Fax | 877-684-1686
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Provider Business Mailing Address
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Address Line | 4619 ENFIELD DR
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City | GAINESVILLE
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State | GA
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Zip | 30506-4663
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Country | US
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Telephone | 404-771-0178
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Fax | 770-219-2664
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW007868
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License Number State | GA
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