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General NPI Number Information
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NPI Number | 1548017031
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Entity Type | Organization
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Legal Business Name | LAKE OCONEE MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 05/02/2024
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 114 HARMONY XING STE 1
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City | EATONTON
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State | GA
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Zip | 31024-9546
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Country | US
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Telephone | 706-484-0884
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Fax |
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Provider Business Mailing Address
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Address Line | 114 HARMONY XING STE 1
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City | EATONTON
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State | GA
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Zip | 31024-9546
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Country | US
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Telephone | 706-484-0884
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMEELAH GATER
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Credential | MD
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Telephone | 706-816-2607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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