=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689167314
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCONEE SURGICAL & PEDIATRIC ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2018
-----------------------------------------------------
Last Update Date | 06/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 N COBB ST
-----------------------------------------------------
City | MILLEDGEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31061-2683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-453-0230
-----------------------------------------------------
Fax | 478-453-0940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 N COBB ST
-----------------------------------------------------
City | MILLEDGEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31061-2683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-453-0230
-----------------------------------------------------
Fax | 478-453-0940
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. HARINDER SINGH BRAR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 478-453-0230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------