Healthcare Provider Details

I. General information

NPI: 1245117894
Provider Name (Legal Business Name): AMARI OLIVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 PEACHTREE RD NE
BROOKHAVEN GA
30319-2729
US

IV. Provider business mailing address

3230 MERCER UNIVERSITY DR APT 217
ATLANTA GA
30341-5658
US

V. Phone/Fax

Practice location:
  • Phone: 404-814-9199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13187
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: