Healthcare Provider Details

I. General information

NPI: 1932028735
Provider Name (Legal Business Name): OAKLAND SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4609 ERNEST DR
FOREST PARK GA
30297-3573
US

IV. Provider business mailing address

4609 ERNEST DR
FOREST PARK GA
30297-3573
US

V. Phone/Fax

Practice location:
  • Phone: 713-755-6565
  • Fax:
Mailing address:
  • Phone: 713-755-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: NANCY KNIGHT
Title or Position: MANAGER
Credential:
Phone: 713-755-6565