Healthcare Provider Details

I. General information

NPI: 1265546667
Provider Name (Legal Business Name): JOSEPH ANDREW OLIVER III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E MAIN ST
ROCKWELL NC
28138-6761
US

IV. Provider business mailing address

PO BOX 1060 316 EAST MAIN STREET
ROCKWELL NC
28138-1060
US

V. Phone/Fax

Practice location:
  • Phone: 704-279-2181
  • Fax: 704-279-8984
Mailing address:
  • Phone: 704-279-2181
  • Fax: 704-279-8984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95-01366
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: