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General NPI Number Information
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NPI Number | 1124329628
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Entity Type | Individual
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Provider Name | DR. OSCAR CORNELL GAINES
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Gender | Male
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 1380 DOGWOOD DR SE
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City | CONYERS
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State | GA
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Zip | 30013-5039
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Country | US
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Telephone | 615-327-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 COMMODORE DR
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City | MACON
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State | GA
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Zip | 31211-2606
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Country | US
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Telephone | 478-742-3215
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Fax | 478-742-3215
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 030410
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License Number State | GA
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