Healthcare Provider Details

I. General information

NPI: 1144739111
Provider Name (Legal Business Name): ELIZABETH LOUISE FARRELL OPPENHEIM PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH FARRELL

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

2700 LAUREL RIDGE DR
DECATUR GA
30033-2934
US

V. Phone/Fax

Practice location:
  • Phone: 503-522-0071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN211195
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN211195
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN211195
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: