Provider Demographics
NPI:1013021781
Name:OLIGA, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:OLIGA
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:PO BOX 934915
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-4915
Mailing Address - Country:US
Mailing Address - Phone:404-501-7969
Mailing Address - Fax:404-501-3874
Practice Address - Street 1:4153B FLAT SHOALS PKWY
Practice Address - Street 2:STE 200
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4189
Practice Address - Country:US
Practice Address - Phone:404-585-5049
Practice Address - Fax:404-591-0292
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39890207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G28441Medicare UPIN
G28441Medicare UPIN
GA11BDKXTMedicare ID - Type Unspecified
5523488OtherAETNA
617677OtherBLUE CROSS BLUE SHIELD
110121149Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE