Healthcare Provider Details

I. General information

NPI: 1629049127
Provider Name (Legal Business Name): OCONEE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15579 WELLS HIGHWAY
SENECA SC
29678-4318
US

IV. Provider business mailing address

15579 WELLS HIGHWAY
SENECA SC
29678-4318
US

V. Phone/Fax

Practice location:
  • Phone: 864-882-7800
  • Fax: 864-882-5908
Mailing address:
  • Phone: 864-882-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANK A STEWART
Title or Position: BUSINESS OWNER
Credential: D.O.
Phone: 864-882-7800