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General NPI Number Information
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NPI Number | 1568852366
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Entity Type | Individual
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Provider Name | OLIVIA MAZZOLINI FNP
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Gender | Female
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Dates
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Enumeration Date | 01/31/2015
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 3369 BUFORD HWY NE
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City | BROOKHAVEN
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State | GA
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Zip | 30329-3722
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Country | US
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Telephone | 404-321-4692
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Fax |
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Provider Business Mailing Address
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Address Line | 55 PHEASANT DR SE
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City | MARIETTA
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State | GA
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Zip | 30067-4214
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Country | US
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Telephone | 770-833-5570
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Fax |
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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 | RN181352
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License Number State | GA
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