MEDICARE: LINDSEY B OWENS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	RN212480	GA

General Provider Information

NPI Number	:	1417605189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY B OWENS NP

Provider Business Mailing Address
First Line	:	3225 SHALLOWFORD RD STE 1300
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-7033
Country	:	US
Telephone Number	:	678-560-7160
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 SHALLOWFORD RD STE 1300
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-7033
Country	:	US
Telephone Number	:	678-560-7160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2022
Last Update Date	:	03/22/2022

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