Organization
OCONEE PRIMARY CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANELYN F GASTON (PRACTICE ADMINISTRATOR)
(706) 468-4519
Entity
Organization
Contact information
Practice address
411 N COBB ST, MILLEDGEVILLE, GA 31061-2634
(478) 454-3470
Mailing address
411 N COBB ST, MILLEDGEVILLE, GA 31061-2634
(478) 454-3470
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003140021A
—
GA
01
—
202G701823
MEDICARE PTAN
GA
Enumeration date
09/06/2013
Last updated
10/15/2014
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