Provider Demographics
NPI:1285995845
Name:BOLAR, ERICA CHANISE (DNP, FNP-C, APRN)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:CHANISE
Last Name:BOLAR
Suffix:
Gender:F
Credentials:DNP, FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2799 LAWRENCEVILLE HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2517
Mailing Address - Country:US
Mailing Address - Phone:470-375-3115
Mailing Address - Fax:470-375-3117
Practice Address - Street 1:2799 LAWRENCEVILLE HWY STE 106
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2517
Practice Address - Country:US
Practice Address - Phone:470-375-3115
Practice Address - Fax:470-375-3117
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily