Healthcare Provider Details

I. General information

NPI: 1972411593
Provider Name (Legal Business Name): CHEVELLE CARIESHA OLIVER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 HIGHWAY 138 SE
CONYERS GA
30013-0121
US

IV. Provider business mailing address

1705 HIGHWAY 138 SE
CONYERS GA
30013-0121
US

V. Phone/Fax

Practice location:
  • Phone: 404-951-2027
  • Fax:
Mailing address:
  • Phone: 404-951-2027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number286325
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: