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NPI Code Detail

MEDICARE: GEORGIA LEE OLDEN PA-C

MEDICARE: GEORGIA LEE OLDEN PA-C
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
1363A00000XPhysician Assistant10004653AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629806385
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGIA LEE OLDEN PA-C
Provider Business Mailing Address
First Line : 6626 E 75TH ST STE 500
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2890
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7400 N SHADELAND AVE STE 100
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2076
Country : US
Telephone Number : 317-621-6900
Fax Number : 317-621-4460
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2024
Last Update Date : 05/14/2025

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Directions to “ GEORGIA LEE OLDEN PA-C” Practice Location

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