Healthcare Provider Details

I. General information

NPI: 1093771065
Provider Name (Legal Business Name): JOEL RICHARD OLIVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 HIGHWAY 1 S
LUGOFF SC
29078-9630
US

IV. Provider business mailing address

1818 HENDERSON ST
COLUMBIA SC
29201-2647
US

V. Phone/Fax

Practice location:
  • Phone: 803-438-9759
  • Fax: 803-438-9783
Mailing address:
  • Phone: 803-758-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14459
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: