Healthcare Provider Details

I. General information

NPI: 1871457812
Provider Name (Legal Business Name): OLIVIA BROOKE KENDRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W LINE ST STE 4
CALHOUN GA
30701-1837
US

IV. Provider business mailing address

128 JONES AVE
CALHOUN GA
30701-2040
US

V. Phone/Fax

Practice location:
  • Phone: 678-383-0636
  • Fax:
Mailing address:
  • Phone: 706-263-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: