Provider Demographics
NPI:1457047391
Name:NOTSHULWANA, VELILE ARTHUR
Entity type:Individual
Prefix:
First Name:VELILE
Middle Name:ARTHUR
Last Name:NOTSHULWANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3482 MULBERRY LANE WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5410
Mailing Address - Country:US
Mailing Address - Phone:470-886-9059
Mailing Address - Fax:
Practice Address - Street 1:3482 MULBERRY LANE WAY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5410
Practice Address - Country:US
Practice Address - Phone:404-921-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ000000103TC0700X
AZ0000000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical