MEDICARE: MS. OLETHIA HERBERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	3747P1801X	Personal Care Attendant
3	374U00000X	Home Health Aide
4	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1437981826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. OLETHIA HERBERT

Provider Business Mailing Address
First Line	:	PO BOX 4001
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31914-0001
Country	:	US
Telephone Number	:	706-325-8864
Fax Number	:

Provider Business Practice Location Address
First Line	:	1224 PEACOCK AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-6000
Country	:	US
Telephone Number	:	706-325-8864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/15/2024

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