Individual
JACOB ALAN OLIVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2505 NEWPOINT PKWY, LAWRENCEVILLE, GA 30043-6003
(678) 257-7078
Mailing address
4263 WINSLOW HILL CT, SUWANEE, GA 30024-3766
(801) 362-0498
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT004058
GA
Other
Enumeration date
02/15/2022
Last updated
02/15/2022
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