Provider Demographics
NPI:1942669205
Name:GURLEY, ADRIANNE SMILEY
Entity Type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:SMILEY
Last Name:GURLEY
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 1:1299 BATTLECREEK RD STE 210
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-7981
Mailing Address - Country:US
Mailing Address - Phone:678-492-6237
Mailing Address - Fax:850-999-7114
Practice Address - Street 1:6092 IDLEWOOD PASS
Practice Address - Street 2:
Practice Address - City:STONECREST
Practice Address - State:GA
Practice Address - Zip Code:30038-6269
Practice Address - Country:US
Practice Address - Phone:678-492-6237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT6367225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022345600Medicaid
GAOT006367OtherGEORGIA STATE LICENSE
FLOT18152OtherFLORIDA STATE LICENSE