Provider Demographics
NPI:1235215211
Name:MCNULTY, DARLENE ALEXANDRA (DO)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:ALEXANDRA
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:
Other - Last Name:KROT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5775 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:C200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1500
Mailing Address - Country:US
Mailing Address - Phone:678-426-2930
Mailing Address - Fax:404-256-2795
Practice Address - Street 1:5775 PEACHTREE DUNWOODY RD
Practice Address - Street 2:C 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1500
Practice Address - Country:US
Practice Address - Phone:678-426-2930
Practice Address - Fax:404-256-2795
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230253283Q00000X
GA0665512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No283Q00000XHospitalsPsychiatric Hospital