MEDICARE: NIKKITA DAVIS-GULLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1174276299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKITA DAVIS-GULLEY

Provider Business Mailing Address
First Line	:	2131 KINGSTON CT SE STE 100
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8929
Country	:	US
Telephone Number	:	470-303-3803
Fax Number	:

Provider Business Practice Location Address
First Line	:	2131 KINGSTON CT SE STE 100
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8929
Country	:	US
Telephone Number	:	470-303-3803
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2022
Last Update Date	:	01/28/2022

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Directions to “ NIKKITA DAVIS-GULLEY ” Practice Location

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