Healthcare Provider Details

I. General information

NPI: 1689678377
Provider Name (Legal Business Name): DOUGLAS ARLAN OLSON II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY ROAD NE
ATLANTA GA
30342
US

IV. Provider business mailing address

6280 LAKEAIRES DR
CUMMING GA
30040-4292
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-6936
  • Fax:
Mailing address:
  • Phone: 770-886-3219
  • Fax: 770-886-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number051073
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: