Provider Demographics
NPI:1003352774
Name:OLAN HEALTHCARE CLINIC
Entity Type:Organization
Organization Name:OLAN HEALTHCARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-613-2971
Mailing Address - Street 1:7050 JIMMY CARTER BLVD
Mailing Address - Street 2:STE 212
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3257
Mailing Address - Country:US
Mailing Address - Phone:770-441-9585
Mailing Address - Fax:
Practice Address - Street 1:7050 JIMMY CARTER BLVD
Practice Address - Street 2:STE 212
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3257
Practice Address - Country:US
Practice Address - Phone:770-441-9585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty