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NPI Code Detail

MEDICARE: OLISTELL, INC.

MEDICARE: OLISTELL, INC.
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
1251E00000XHome Health Agency056-R-0004GA

General Provider Information

NPI Number : 1841269768
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLISTELL, INC.
Provider Business Mailing Address
First Line : 290 HIGHWAY 314
Second Line : SUITE C
City : FAYETTEVILLE
State : GA
Zip : 30214-7813
Country : US
Telephone Number : 770-719-8454
Fax Number : 770-719-2532
Provider Business Practice Location Address
First Line : 290 HIGHWAY 314
Second Line : SUITE C
City : FAYETTEVILLE
State : GA
Zip : 30214-7813
Country : US
Telephone Number : 770-719-8454
Fax Number : 770-719-2532
Authorized Official
Title or Position : CEO
Name : MR. BENJAMIN O. DAVIES
Credential :
Telephone Number : 770-719-5229
Provider Enumeration Date : 03/14/2006
Last Update Date : 08/22/2020

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