Provider Demographics
NPI:1245386820
Name:FUTRELL, MISTY ANN
Entity Type:Individual
Prefix:MS
First Name:MISTY
Middle Name:ANN
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 GAISSERT RD
Mailing Address - Street 2:
Mailing Address - City:NEWBORN
Mailing Address - State:GA
Mailing Address - Zip Code:30056-2898
Mailing Address - Country:US
Mailing Address - Phone:770-842-5115
Mailing Address - Fax:
Practice Address - Street 1:1430 STARCREST DRIVE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012
Practice Address - Country:US
Practice Address - Phone:770-785-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker