MEDICARE: LOWER OCONEE COMMUNITY HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1518215854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWER OCONEE COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	22 MAIN ST
Second Line	:
City	:	LUMBER CITY
State	:	GA
Zip	:	31549-0519
Country	:	US
Telephone Number	:	912-363-4389
Fax Number	:	912-363-1377

Provider Business Practice Location Address
First Line	:	22 MAIN ST
Second Line	:
City	:	LUMBER CITY
State	:	GA
Zip	:	31549-0519
Country	:	US
Telephone Number	:	912-363-4389
Fax Number	:	912-363-1377

Authorized Official
Title or Position	:	CEO
Name	:	PEYTON SMITH
Credential	:
Telephone Number	:	912-523-5113

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	08/16/2012

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