Healthcare Provider Details

I. General information

NPI: 1003792623
Provider Name (Legal Business Name): OLIVIA WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 09/11/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 PINE GROVE RD
LOCUST GROVE GA
30248-2561
US

IV. Provider business mailing address

2683 COUNTY ROAD 29
ALBERTA AL
36720-2810
US

V. Phone/Fax

Practice location:
  • Phone: 800-949-8270
  • Fax:
Mailing address:
  • Phone: 678-427-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: