Healthcare Provider Details

I. General information

NPI: 1487454823
Provider Name (Legal Business Name): LINDSAY FUSON WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 ROE HAMPTON LN
STONE MOUNTAIN GA
30087-2502
US

IV. Provider business mailing address

196 ROE HAMPTON LN
STONE MOUNTAIN GA
30087-2502
US

V. Phone/Fax

Practice location:
  • Phone: 206-683-2128
  • 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 Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LINDSAY FUSON
Title or Position: NURSE PRACTITIONER/OWNER
Credential: NP
Phone: 206-683-2128