Provider Demographics
NPI:1023351210
Name:MOLLISON, LORNA ANGELA (RN)
Entity type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:ANGELA
Last Name:MOLLISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 HARVEST DALE CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2754
Mailing Address - Country:US
Mailing Address - Phone:678-777-5119
Mailing Address - Fax:770-413-3821
Practice Address - Street 1:1203 HARVEST DALE CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-2754
Practice Address - Country:US
Practice Address - Phone:678-777-5119
Practice Address - Fax:770-413-3821
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA37500000X372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider