MEDICARE: ANGELA OLIVER FNP-BC

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	363L00000X	Nurse Practitioner	APRN-NP710645	GA

General Provider Information

NPI Number	:	1962340539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA OLIVER FNP-BC

Provider Business Mailing Address
First Line	:	1700 NORTHSIDE DR NW STE A7
Second Line	:	PMB 711
City	:	ATLANTA
State	:	GA
Zip	:	30318-2695
Country	:	US
Telephone Number	:	404-980-2598
Fax Number	:

Provider Business Practice Location Address
First Line	:	3016 ATLANTA RD SE STE 150
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-3856
Country	:	US
Telephone Number	:	404-383-0845
Fax Number	:

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	04/13/2026

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