Provider Demographics
NPI:1346784055
Name:OLAN COMPREHENSIVE HEALTHCARE
Entity Type:Organization
Organization Name:OLAN COMPREHENSIVE HEALTHCARE
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:NECOLE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-613-2971
Mailing Address - Street 1:2169 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7710
Mailing Address - Country:US
Mailing Address - Phone:770-962-3700
Mailing Address - Fax:770-962-8063
Practice Address - Street 1:2169 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7710
Practice Address - Country:US
Practice Address - Phone:770-962-3700
Practice Address - Fax:770-962-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty