Provider Demographics
NPI:1841036118
Name:OLIVER, ANNIKA NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:NICOLE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3507
Mailing Address - Country:US
Mailing Address - Phone:770-945-4800
Mailing Address - Fax:
Practice Address - Street 1:2721 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3507
Practice Address - Country:US
Practice Address - Phone:770-945-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA051673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty