Healthcare Provider Details

I. General information

NPI: 1780176933
Provider Name (Legal Business Name): LINDSAY FUSON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 KENTUCKY ST # 159
SCOTTDALE GA
30079-1124
US

IV. Provider business mailing address

196 ROE HAMPTON LN
STONE MOUNTAIN GA
30087-2502
US

V. Phone/Fax

Practice location:
  • Phone: 470-713-0525
  • Fax:
Mailing address:
  • Phone: 206-683-2128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN262280
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN262280
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: