Provider Demographics
NPI:1134489891
Name:OLLE, LYNDA GARNER
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:GARNER
Last Name:OLLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2899 NEWBERRY WAY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6071
Mailing Address - Country:US
Mailing Address - Phone:678-290-8648
Mailing Address - Fax:
Practice Address - Street 1:2899 NEWBERRY WAY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6071
Practice Address - Country:US
Practice Address - Phone:678-290-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator