MEDICARE: DR. RAYMOND PAUL OLIGA PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY0002490	GA

General Provider Information

NPI Number	:	1356323299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND PAUL OLIGA PSYD

Provider Business Mailing Address
First Line	:	1533 GRANBY LN
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248-7032
Country	:	US
Telephone Number	:	770-288-2609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 GRANBY LN
Second Line	:
City	:	LOCUST GROVE
State	:	GA
Zip	:	30248-7032
Country	:	US
Telephone Number	:	404-808-2330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	06/14/2020

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