MEDICARE: MS. SUSAN H OLSEN CNM

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	367A00000X	Advanced Practice Midwife	RN063656	GA

General Provider Information

NPI Number	:	1659361384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN H OLSEN CNM

Provider Business Mailing Address
First Line	:	1700 HOSPITAL SOUTH DR STE 504
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-8159
Country	:	US
Telephone Number	:	770-819-9211
Fax Number	:	770-819-9616

Provider Business Practice Location Address
First Line	:	1700 HOSPITAL SOUTH DR STE 504
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-8159
Country	:	US
Telephone Number	:	770-819-9211
Fax Number	:	770-819-9616

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	03/12/2012

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