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General NPI Number Information
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NPI Number | 1245386820
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Entity Type | Individual
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Provider Name | MS. MISTY ANN FUTRELL
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1430 STARCREST DRIVE
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City | CONYERS
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State | GA
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Zip | 30012
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Country | US
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Telephone | 770-785-5910
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Fax |
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Provider Business Mailing Address
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Address Line | 2147 GAISSERT RD
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City | NEWBORN
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State | GA
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Zip | 30056-2898
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Country | US
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Telephone | 770-842-5115
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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