Provider Demographics
NPI:1174400816
Name:GULLATT, TREVIS (RN)
Entity type:Individual
Prefix:
First Name:TREVIS
Middle Name:
Last Name:GULLATT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 GRADY PL SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-2615
Mailing Address - Country:US
Mailing Address - Phone:404-849-5973
Mailing Address - Fax:
Practice Address - Street 1:3409 ESTELLE ST
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1402
Practice Address - Country:US
Practice Address - Phone:404-849-5973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
GA210650163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No163W00000XNursing Service ProvidersRegistered Nurse