Individual
DR. MARK CUSTODIO OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2416 CAPSTONE CT, COLUMBUS, GA 31909-2795
(706) 327-1281
Mailing address
2416 CAPSTONE CT, COLUMBUS, GA 31909-2795
(706) 327-1281
(706) 576-9714
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
048557
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00867765A
—
GA
01
—
048557
LICENSE NUMBER
GA
Enumeration date
08/21/2006
Last updated
03/20/2020
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