Healthcare Provider Details

I. General information

NPI: 1417605189
Provider Name (Legal Business Name): LINDSEY B OWENS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 SHALLOWFORD RD STE 1300
MARIETTA GA
30062-7033
US

IV. Provider business mailing address

3225 SHALLOWFORD RD STE 1300
MARIETTA GA
30062-7033
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-7160
  • Fax:
Mailing address:
  • Phone: 678-560-7160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN212480
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: