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General NPI Number Information
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NPI Number | 1154756369
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Entity Type | Organization
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Legal Business Name | OCONEE PRIMARY CARE CENTER, LLC
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 411 N COBB ST
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-2634
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Country | US
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Telephone | 478-454-3470
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Fax |
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Provider Business Mailing Address
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Address Line | 411 N COBB ST
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-2634
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Country | US
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Telephone | 478-454-3470
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | JANELYN F GASTON
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Credential |
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Telephone | 706-468-4519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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