Healthcare Provider Details

I. General information

NPI: 1649113770
Provider Name (Legal Business Name): OLYMPIA HIGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1544 BASS RD
MACON GA
31210-7510
US

IV. Provider business mailing address

1544 BASS RD
MACON GA
31210-7510
US

V. Phone/Fax

Practice location:
  • Phone: 478-471-4494
  • Fax:
Mailing address:
  • Phone: 205-545-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP312381
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: