MEDICARE: PHILIP MATTHEW OCONNELL MD

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	207Q00000X	Family Medicine Physician	69080	GA

General Provider Information

NPI Number	:	1518930841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP MATTHEW OCONNELL MD

Provider Business Mailing Address
First Line	:	2060 DAN PROCTOR DRIVE SUITE 2100
Second Line	:	SOUTHEAST GEORGIA HEALTH SYSTEM
City	:	ST. MARYS
State	:	GA
Zip	:	31558
Country	:	US
Telephone Number	:	912-882-6767
Fax Number	:	912-882-6411

Provider Business Practice Location Address
First Line	:	2060 DAN PROCTOR DRIVE SUITE 2100
Second Line	:	SOUTHEAST GEORGIA HEALTH SYSTEM
City	:	ST. MARYS
State	:	GA
Zip	:	31558
Country	:	US
Telephone Number	:	912-882-6767
Fax Number	:	912-882-6411

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	03/01/2016

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