Organization
LOWER OCONEE COMMUNITY HOSPITAL, INC
Active
Other names
MONTGOMERY INTERNAL MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
LYNAN FOWLER (BUSINESS OFFICE)
(912) 523-5113
Entity
Organization
Contact information
Practice address
441 W BROAD STREET, MOUNT VERNON, GA 30445-2629
(912) 583-2229
Mailing address
441 W BROAD STREET, PO BOX 546, MOUNT VERNON, GA 30445-2629
(912) 583-2229
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
208152021
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
324829478B
—
GA
Enumeration date
03/20/2007
Last updated
07/11/2013
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