Healthcare Provider Details

I. General information

NPI: 1871405332
Provider Name (Legal Business Name): EMMA LAVIOLETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 JEFFERSON PL
ATHENS GA
30601-1761
US

IV. Provider business mailing address

2250 SANDY LANDING DR
ELBERTON GA
30635-1120
US

V. Phone/Fax

Practice location:
  • Phone: 706-548-0058
  • Fax:
Mailing address:
  • Phone: 706-988-3940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number311821
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: