Carl Glenn Oliver, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

04064 Issued in GA

Practice address

502 Sumter St
Montezuma, GA 31063-1734

Phone

(478) 472-8178

Fax

(478) 472-3289

NPI assigned

Sep 21, 2005

Last updated

Aug 17, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Premier Healthcare Investments

  dba Flint River Hospital

  • General Acute Care Hospital
  • Montezuma, GA
  • NPI 1528497351
  NPD
• Albany Arthritis & Orthopaedic Center

  • Orthopaedic Surgery Physician
  • Albany, GA
  • NPI 1154472447
  NPD (past)
• Flint River Medi Cal Group, LLC

  • Surgery Physician
  • Montezuma, GA
  • NPI 1235340969
  NPD (past)
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  NPD (past)
• Southwestern Emergency Physicians PC

  • Emergency Medicine Physician
  • Albany, GA
  • NPI 1356336986
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471392000000",
    "number": "1013903426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 SUMTER ST",
            "city": "MONTEZUMA",
            "state": "GA",
            "postal_code": "310631734",
            "telephone_number": "478-472-8178",
            "fax_number": "478-472-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 SUMTER ST",
            "city": "MONTEZUMA",
            "state": "GA",
            "postal_code": "310631734",
            "telephone_number": "478-472-8178",
            "fax_number": "478-472-3289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVER",
        "first_name": "CARL",
        "middle_name": "GLENN",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2016-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "04064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "455252909A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "364910",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Montezuma Health Care Center LLC (Montezuma Health Care Center)
• Montezuma Health Care Center LLC (Montezuma Health Care Center)
• Montezuma Health Care Center LLC (Montezuma Health Care Center)
• Robert Leonard Moretz, DMD
• Nelson T. Madrazo (Sumter Pediatrics)
• Jessica W Pipkin, PHARMD
• Premier Healthcare Investments (Flint River Hospital)
• Premier Healthcare Investments (Flint River Hospital)
• Premier Healthcare Investments (Flint River Rural Health Clinic - Oglethorpe)
• Premier Healthcare Investments (Riverside Treatment Center, Flint River Hospital)

• Medical Physician Assistant in Montezuma, GA
• Providers in Montezuma, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.