Provider Demographics
NPI:1457534711
Name:OLIVER, GAYLAND ANTHONY (BA, MBA, CFTS)
Entity Type:Individual
Prefix:MR
First Name:GAYLAND
Middle Name:ANTHONY
Last Name:OLIVER
Suffix:
Gender:M
Credentials:BA, MBA, CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 W MEADOWVIEW RD STE 209
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3706
Mailing Address - Country:US
Mailing Address - Phone:336-843-9377
Mailing Address - Fax:336-203-6130
Practice Address - Street 1:2302 W MEADOWVIEW RD STE 209
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3706
Practice Address - Country:US
Practice Address - Phone:336-843-9377
Practice Address - Fax:336-203-6130
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704655Medicaid
NC5801540001Medicare NSC
NC7704655Medicaid