Healthcare Provider Details

I. General information

NPI: 1568852366
Provider Name (Legal Business Name): OLIVIA MAZZOLINI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2015
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3369 BUFORD HWY NE
BROOKHAVEN GA
30329-3722
US

IV. Provider business mailing address

55 PHEASANT DR SE
MARIETTA GA
30067-4214
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-4692
  • Fax:
Mailing address:
  • Phone: 770-833-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN181352
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: