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General NPI Number Information
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NPI Number | 1073616058
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Entity Type | Organization
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Legal Business Name | OCONEE G.I. CLINIC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 12 BOARDWALK PL SUITE 1A
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City | SENECA
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State | SC
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Zip | 29678-2671
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Country | US
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Telephone | 864-882-5933
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2020
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City | SENECA
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State | SC
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Zip | 29679-2020
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Country | US
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Telephone | 864-882-5933
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Fax | 864-885-9404
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Authorized Official
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Title or Position | MANAGER
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Name | SUSAN RAWL
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Credential |
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Telephone | 864-882-5933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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