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General NPI Number Information
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NPI Number | 1871434175
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Entity Type | Organization
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Legal Business Name | OLIVE GARDEN HEALTHCARE SERVICE
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 3004 FAIRVIEW RD
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City | COVINGTON
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State | GA
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Zip | 30016-1117
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Country | US
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Telephone | 404-808-4583
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Fax |
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Provider Business Mailing Address
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Address Line | 3004 FAIRVIEW RD
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City | COVINGTON
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State | GA
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Zip | 30016-1117
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND AUTHORIZED OFFICIAL
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Name | DORCAS BOLAJI
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Credential |
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Telephone | 404-808-4583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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