Provider Demographics
NPI:1689678377
Name:OLSON, DOUGLAS ARLAN II (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ARLAN
Last Name:OLSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 LAKEAIRES DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-4292
Mailing Address - Country:US
Mailing Address - Phone:770-886-3219
Mailing Address - Fax:770-886-3219
Practice Address - Street 1:1000 JOHNSON FERRY ROAD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-851-6936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051073207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000948186CMedicaid
GA000948186EMedicaid
GA198022OtherBCBS
GA10040783OtherAMERIGROUP
GA196701OtherBCBS
SCG51073Medicaid
GA000948186DMedicaid
GA334611OtherWELLCARE
GAP00311294Medicare PIN
GA10040783OtherAMERIGROUP
GA000948186EMedicaid
GA93BFBTGMedicare PIN