MEDICARE: FLEUR DE LIS HEALTH SOLUTIONS OF GEORGIA, LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1487401352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLEUR DE LIS HEALTH SOLUTIONS OF GEORGIA, LLC

Provider Business Mailing Address
First Line	:	653 ROBERTS DR STE A10
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2959
Country	:	US
Telephone Number	:	404-678-3969
Fax Number	:	404-779-7668

Provider Business Practice Location Address
First Line	:	653 ROBERTS DR STE A10
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2959
Country	:	US
Telephone Number	:	404-678-3969
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADREONNE LEWIS HOUSTON
Credential	:	FNP-C
Telephone Number	:	404-678-3969

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	11/11/2025

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