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General NPI Number Information
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NPI Number | 1881899458
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Entity Type | Organization
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Legal Business Name | OCONEE PATHOLOGY ASSOCIATES, P.C.
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 821 N COBB ST PATHOLOGY DEPARTMENT
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-2343
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Country | US
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Telephone | 478-454-3688
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Fax | 478-454-3694
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Provider Business Mailing Address
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Address Line | PO BOX 1705
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City | MILLEDGEVILLE
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State | GA
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Zip | 31059-1705
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Country | US
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Telephone | 478-454-3688
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REGINALD WENDALL WILSON
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Credential | M.D.
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Telephone | 478-454-3688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 030927
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License Number State | GA
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