Provider Demographics
NPI:1134257686
Name:COULTES, DENISE (NP-C)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:COULTES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 EXECUTIVE PARK SOUTH NE
Mailing Address - Street 2:SUITE 2090
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2208
Mailing Address - Country:US
Mailing Address - Phone:404-778-6296
Mailing Address - Fax:404-778-7208
Practice Address - Street 1:59 EXECUTIVE PARK SOUTH NE
Practice Address - Street 2:SUITE 2090
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2208
Practice Address - Country:US
Practice Address - Phone:404-778-6296
Practice Address - Fax:404-778-7208
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN126619NP363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP41251Medicare UPIN