Provider Demographics
NPI:1306132410
Name:OCMULGEE UROLOGY, LLC
Entity type:Organization
Organization Name:OCMULGEE UROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFP
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-448-4050
Mailing Address - Street 1:PO BOX 4128
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-4128
Mailing Address - Country:US
Mailing Address - Phone:478-448-4416
Mailing Address - Fax:478-448-4423
Practice Address - Street 1:1111 GRIFFIN AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-9101
Practice Address - Country:US
Practice Address - Phone:478-448-4416
Practice Address - Fax:478-448-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty