Organization
PREMIUM CARE HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLUSOLA OLAWALE NP (AUTHORIZED OFFICIAL)
(614) 599-3617
Entity
Organization
Contact information
Practice address
1684 THORN RIDGE TRL, HAMPTON, GA 30228-6129
(614) 599-3617
(877) 779-5837
Mailing address
1684 THORN RIDGE TRL, HAMPTON, GA 30228-6129
(614) 599-3617
(877) 779-5837
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/21/2018
Last updated
04/03/2020
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