Provider Demographics
NPI:1750906368
Name:SOLOMON, AMELIA MICHELLE
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:MICHELLE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3276 BUFORD DR STE 104-280
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-5702
Mailing Address - Country:US
Mailing Address - Phone:470-350-8637
Mailing Address - Fax:206-401-5911
Practice Address - Street 1:1422 FOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3990
Practice Address - Country:US
Practice Address - Phone:470-350-8637
Practice Address - Fax:206-401-5911
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-2030374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide