Provider Demographics
NPI:1821559642
Name:OLSON, SAMUEL BLAKE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BLAKE
Last Name:OLSON
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:B
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL CT
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2077
Practice Address - Country:US
Practice Address - Phone:706-602-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN236549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily