Individual
MR. CARL GLENN OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
502 SUMTER ST, MONTEZUMA, GA 31063-1734
(478) 472-8178
(478) 472-3289
Mailing address
502 SUMTER ST, MONTEZUMA, GA 31063-1734
(478) 472-8178
(478) 472-3289
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
04064
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
364910
WELLCARE
GA
05
—
455252909A
—
GA
Enumeration date
09/21/2005
Last updated
08/17/2016
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