Healthcare Provider Details

I. General information

NPI: 1205458510
Provider Name (Legal Business Name): EMILY ELIZABETH OLINGER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 08/01/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97TH MEDICAL GROUP 301 N. FIRST ST
ALTUS AFB OK
73523
US

IV. Provider business mailing address

607 BEAMAN ST
CLINTON NC
28328
US

V. Phone/Fax

Practice location:
  • Phone: 580-481-5405
  • Fax:
Mailing address:
  • Phone: 910-592-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023-02338
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: