Individual
MICHAEL RYAN OLDENBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
400 TOWER RD NE STE 200, MARIETTA, GA 30060-9412
(770) 422-1372
Mailing address
677 CHURCH ST NE, MARIETTA, GA 30060-1101
(770) 793-5000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN259503
GA
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
RN259503
GA
Other
Enumeration date
01/04/2020
Last updated
10/05/2021
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