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NPI Code Detail

MEDICARE: ELIZABETH BOLEN

MEDICARE: ELIZABETH BOLEN
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
1163W00000XRegistered NurseR064504AR

General Provider Information

NPI Number : 1902769896
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH BOLEN
Provider Business Mailing Address
First Line : 255 E PACES FERRY RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30305-2233
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 255 E PACES FERRY RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30305-2233
Country : US
Telephone Number : 606-614-9569
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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