Provider Demographics
NPI:1568901445
Name:FLORY, OLIVIA MARY (PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARY
Last Name:FLORY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:MARY
Other - Last Name:LEHOTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4539
Mailing Address - Country:US
Mailing Address - Phone:770-831-5525
Mailing Address - Fax:770-831-5527
Practice Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4539
Practice Address - Country:US
Practice Address - Phone:770-831-5525
Practice Address - Fax:770-831-5527
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7903363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical