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General NPI Number Information
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NPI Number | 1639689136
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Entity Type | Organization
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Legal Business Name | OCONEE NEUROLOGY, LLC
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 10/10/2017
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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 | 478-454-1014
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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 | 478-454-1014
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES A WILSON
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Credential | MD
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Telephone | 478-454-1034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 054702
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License Number State | GA
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