MEDICARE: MALLORY NOLAN

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	RN306431	GA

General Provider Information

NPI Number	:	1740987478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY NOLAN

Provider Business Mailing Address
First Line	:	99 KROG ST NE STE C110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2677
Country	:	US
Telephone Number	:	404-885-8542
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 KROG ST NE STE C110
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2677
Country	:	US
Telephone Number	:	404-885-8542
Fax Number	:	404-393-9936

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

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	02/05/2026

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Directions to “ MALLORY NOLAN ” Practice Location

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