Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 024851 | GA |
NPI | 1003802117 |
---|---|
Provider Name | Dr. John Henry Oliver |
First Address | Augusta, GA 30904-6220 |
Second Address | Augusta, GA 30904-6220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 07/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00447774A | (05) | GA |
D40777 | (02) | |
G24851 | MEDICIAD (01) | SC |