Provider Demographics
NPI:1609121110
Name:SOLLIE, MICHAEL ELAND (NP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ELAND
Last Name:SOLLIE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:678-388-1577
Mailing Address - Fax:
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 460
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:678-388-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197261-NP363L00000X
NC265595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126014CMedicaid
GA003126014JMedicaid
GA003126014LMedicaid
GA003126014MMedicaid
GA003126014AMedicaid
GA003126014GMedicaid
GA003126014HMedicaid
GA003126014IMedicaid
GA003126014OMedicaid
GA003126014KMedicaid
GARN197261OtherLICENSE
GA003126014BMedicaid
GA003126014DMedicaid
GA003126014EMedicaid
GA003126014FMedicaid
GA003126014NMedicaid
GA003126014HMedicaid