MEDICARE: OCONEE WHOLESOME MEDICAL LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1518667781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCONEE WHOLESOME MEDICAL LLC

Provider Business Mailing Address
First Line	:	1800 HOG MOUNTAIN RD STE 103
Second Line	:
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-1935
Country	:	US
Telephone Number	:	706-769-8800
Fax Number	:	706-769-8565

Provider Business Practice Location Address
First Line	:	1800 HOG MOUNTAIN RD STE 103
Second Line	:
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-1935
Country	:	US
Telephone Number	:	706-769-8800
Fax Number	:	706-769-8565

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	NEDSELY ANA VILA ALMONTE
Credential	:	MC
Telephone Number	:	203-873-9206

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	03/17/2023

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Directions to “OCONEE WHOLESOME MEDICAL LLC ” Practice Location

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