MEDICARE: OLIVIA LEE WHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	RN310079	GA
2	163W00000X	Registered Nurse	1-157891	AL
3	363LW0102X	Women's Health Nurse Practitioner	APRN-310079	GA

General Provider Information

NPI Number	:	1932661865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA LEE WHNP-BC

Provider Business Mailing Address
First Line	:	3200 DOWNWOOD CIR NW STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-1611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 DOWNWOOD CIR NW STE 220
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-1611
Country	:	US
Telephone Number	:	404-312-3696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	12/24/2025

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