Healthcare Provider Details

I. General information

NPI: 1841086766
Provider Name (Legal Business Name): DUSTIN ROLAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PEACHTREE ST NE
ATLANTA GA
30308-2309
US

IV. Provider business mailing address

615 PEACHTREE ST NE
ATLANTA GA
30308-2309
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-2690
  • Fax: 404-251-1245
Mailing address:
  • Phone: 404-251-2690
  • Fax: 404-251-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN251525
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: