Individual
KENNETH SHULTS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2394
(678) 212-6343
Mailing address
2053 POWERS FERRY RD SE, APT. D, MARIETTA, GA 30067-9675
(904) 534-4725
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/17/2014
Last updated
03/17/2014
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