Provider Demographics
NPI:1982397402
Name:OLDS, CORY ALLEN
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:ALLEN
Last Name:OLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 WOODHILL CIR
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-5930
Mailing Address - Country:US
Mailing Address - Phone:706-905-8055
Mailing Address - Fax:
Practice Address - Street 1:1560 S EUFAULA AVE STE 9
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-3291
Practice Address - Country:US
Practice Address - Phone:706-905-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician