Healthcare Provider Details

I. General information

NPI: 1679106298
Provider Name (Legal Business Name): AIMEE BOLSTEIN CORNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

508 RISING DR
WOODSTOCK GA
30189-6939
US

V. Phone/Fax

Practice location:
  • Phone: 470-788-1010
  • Fax:
Mailing address:
  • Phone: 404-548-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN161109
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: