Provider Demographics
NPI:1003802117
Name:OLIVER, JOHN HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 WRIGHTSBORO RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6220
Mailing Address - Country:US
Mailing Address - Phone:706-737-3948
Mailing Address - Fax:706-737-4035
Practice Address - Street 1:2300 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6220
Practice Address - Country:US
Practice Address - Phone:706-737-3948
Practice Address - Fax:706-737-4035
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024851207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00447774AMedicaid
SCG24851OtherMEDICIAD
16BDCDGMedicare ID - Type Unspecified
D40777Medicare UPIN