Healthcare Provider Details

I. General information

NPI: 1316603459
Provider Name (Legal Business Name): THIELELA N SOLOMON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LELA SOLOMON

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

PO BOX 244221
ATLANTA GA
30324-2404
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-2000
  • Fax:
Mailing address:
  • Phone: 706-773-1755
  • Fax: 678-506-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN307110
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: