Individual
KATIA FAYOLA OUTLAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
550 PEACHTREE ST NE STE 1600, ATLANTA, GA 30308-2246
(404) 298-8998
Mailing address
5582 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3215
(404) 307-4445
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704254995
MI
363LF0000X
Family Nurse Practitioner
Primary
281863
NC
363LF0000X
Family Nurse Practitioner
4704254995
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720495021
—
NC
05
—
NP3723
—
SC
Enumeration date
07/18/2014
Last updated
03/06/2020
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