=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770822496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCONEE VALLEY HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2013
-----------------------------------------------------
Last Update Date | 05/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 N COBB ST
-----------------------------------------------------
City | MILLEDGEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31061-2635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-414-1414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 803 S MAIN ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30642-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-453-1201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. DAVID RINGER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 706-453-1201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------