Healthcare Provider Details

I. General information

NPI: 1609207034
Provider Name (Legal Business Name): ONESOURCE HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N SLAPPEY BLVD
ALBANY GA
31701-1413
US

IV. Provider business mailing address

701 N SLAPPEY BLVD
ALBANY GA
31701-1413
US

V. Phone/Fax

Practice location:
  • Phone: 229-300-5896
  • Fax: 229-482-8586
Mailing address:
  • Phone: 229-300-5896
  • Fax: 229-482-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number059237
License Number StateGA

VIII. Authorized Official

Name: JONATHAN S WILLIAMS
Title or Position: CMO
Credential: D.O.
Phone: 229-300-5896