Provider Demographics
NPI:1013446426
Name:LOLLEY, KAREN (NP-C)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:LOLLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 GILLUM DR STE 3
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-1667
Mailing Address - Country:US
Mailing Address - Phone:706-229-9709
Mailing Address - Fax:833-940-3611
Practice Address - Street 1:443 GILLUM DR STE 3
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-1667
Practice Address - Country:US
Practice Address - Phone:706-229-9709
Practice Address - Fax:706-229-9779
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169781163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1013446426OtherNPI