Provider Demographics
NPI:1003639519
Name:GULYAMOVA, MEKHRINISO (MS)
Entity type:Individual
Prefix:
First Name:MEKHRINISO
Middle Name:
Last Name:GULYAMOVA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WALTON MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1462
Mailing Address - Country:US
Mailing Address - Phone:404-372-4637
Mailing Address - Fax:
Practice Address - Street 1:11535 PARK WOODS CIR STE A2
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4490
Practice Address - Country:US
Practice Address - Phone:470-210-4684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health