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General NPI Number Information
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NPI Number | 1598832602
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Entity Type | Organization
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Legal Business Name | OCONEE REGIONAL HEALTH VENTURES, INC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 425 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 | 478-454-1034
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Fax | 478-454-1114
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Provider Business Mailing Address
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Address Line | 425 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 | 478-454-1034
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Fax | 478-454-1114
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JAN GASTON
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Credential | ADMINISTRATOR
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | GA
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