Organization
OCONEE PATHOLOGY ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGINALD WENDALL WILSON M.D. (PRESIDENT)
(478) 454-3688
Entity
Organization
Contact information
Practice address
821 N COBB ST, PATHOLOGY DEPARTMENT, MILLEDGEVILLE, GA 31061-2343
(478) 454-3688
(478) 454-3694
Mailing address
PO BOX 1705, MILLEDGEVILLE, GA 31059-1705
(478) 454-3688
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
030927
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10049818
AMERIGROUP
GA
01
—
118365
PEACH STATE HLT PLANS
GA
01
—
297058
WELLCARE
GA
01
—
727301
BCBSGA PROVIDER #
GA
01
—
DD8654
RAILROAD MEDICARE
GA
Enumeration date
06/15/2007
Last updated
12/27/2007
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