Provider Demographics
NPI:1003670613
Name:OLIVER, LOLA JAYNE
Entity Type:Individual
Prefix:
First Name:LOLA
Middle Name:JAYNE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 GREATER ZACHARIAH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-3872
Mailing Address - Country:US
Mailing Address - Phone:912-237-3251
Mailing Address - Fax:
Practice Address - Street 1:538 GREATER ZACHARIAH CHURCH RD
Practice Address - Street 2:
Practice Address - City:GLENNVILLE
Practice Address - State:GA
Practice Address - Zip Code:30427-3872
Practice Address - Country:US
Practice Address - Phone:912-237-3251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant