Healthcare Provider Details

I. General information

NPI: 1417952508
Provider Name (Legal Business Name): ELIZABETH KAY BOLTON-HARRIS ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH KAY BOLTON

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 COLLIER RD NW STE 300
ATLANTA GA
30309-1709
US

IV. Provider business mailing address

275 COLLIER RD NW STE 300
ATLANTA GA
30309-1709
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-9815
  • Fax: 404-350-0529
Mailing address:
  • Phone: 404-355-9815
  • Fax: 404-350-0529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRNNP135828
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: