MEDICARE: LOWER OCONEE COMMUNITY HOSPITAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		GA

General Provider Information

NPI Number	:	1043477193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWER OCONEE COMMUNITY HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	280 E WILLOW CREEK LN
Second Line	:
City	:	MC RAE
State	:	GA
Zip	:	31055-5180
Country	:	US
Telephone Number	:	229-868-4122
Fax Number	:	229-868-4124

Provider Business Practice Location Address
First Line	:	280 E WILLOW CREEK LN
Second Line	:
City	:	MC RAE
State	:	GA
Zip	:	31055-2184
Country	:	US
Telephone Number	:	229-868-4122
Fax Number	:	229-868-4124

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	LYNAN P FOWLER
Credential	:
Telephone Number	:	912-523-5113

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	07/07/2011

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