Basic Information
| Provider Information | |||||||||
| NPI: | 1760474456 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVER | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | BLAINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 E GROVER ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281503919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044845100 | ||||||||
| FaxNumber: | 7044845220 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 S POST RD | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281526269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044845100 | ||||||||
| FaxNumber: | 7044845118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 27960 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 174400000X | 27960 | NC | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 891044A | 05 | NC | MEDICAID |