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NPI Code Detail

MEDICARE: JAMES OLIVIERE JR. MD

MEDICARE: JAMES OLIVIERE JR. MD
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician060017GA

General Provider Information

NPI Number : 1891977146
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES OLIVIERE JR. MD
Provider Business Mailing Address
First Line : 1324 HIGHWAY 138 SW
Second Line :
City : RIVERDALE
State : GA
Zip : 30296-1404
Country : US
Telephone Number : 770-907-4949
Fax Number :
Provider Business Practice Location Address
First Line : 1324 HIGHWAY 138 SW
Second Line :
City : RIVERDALE
State : GA
Zip : 30296-1404
Country : US
Telephone Number : 770-907-4949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2007
Last Update Date : 11/28/2007

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