Healthcare Provider Details

I. General information

NPI: 1356804942
Provider Name (Legal Business Name): LORENE WILLIAMS OBERLIES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 PARKWOOD DR
BRUNSWICK GA
31520-4722
US

IV. Provider business mailing address

1305 HORSESHOE DR
BLUE BELL PA
19422-1857
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-7000
  • Fax:
Mailing address:
  • Phone: 864-314-3522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number641916
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN305274
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: