Healthcare Provider Details

I. General information

NPI: 1306904081
Provider Name (Legal Business Name): OCONEE HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 COLAPARCHEE CT
MACON GA
31210-7226
US

IV. Provider business mailing address

PO BOX 26698
MACON GA
31221-6698
US

V. Phone/Fax

Practice location:
  • Phone: 478-972-0277
  • Fax: 888-326-5817
Mailing address:
  • Phone: 404-600-1215
  • Fax: 888-326-5817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: FARHAN SIDDIQUI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 478-972-0277