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General NPI Number Information
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NPI Number | 1306538426
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Entity Type | Individual
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Provider Name | EMILY LOUISE OTHOLD FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 887 W MARIETTA ST NW
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City | ATLANTA
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State | GA
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Zip | 30318-5252
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Country | US
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Telephone | 888-772-0076
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Fax |
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Provider Business Mailing Address
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Address Line | 47 SHORTLEAF TRL
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City | RICHMOND HILL
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State | GA
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Zip | 31324-6555
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Country | US
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Telephone | 774-218-0741
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Fax | 774-218-0741
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN242072
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License Number State | GA
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