MEDICARE: LULA ANDERSON

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1457215014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LULA ANDERSON

Provider Business Mailing Address
First Line	:	8340 SPIVEY RD
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-4116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 N PARK TRL STE 123
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-7373
Country	:	US
Telephone Number	:	470-491-2050
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ LULA ANDERSON ” Practice Location

Language	Start Address	Practice Location

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