Provider Demographics
NPI:1306904081
Name:OCONEE HEALTHCARE CENTER LLC
Entity type:Organization
Organization Name:OCONEE HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FARHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-972-0277
Mailing Address - Street 1:PO BOX 26698
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-6698
Mailing Address - Country:US
Mailing Address - Phone:404-600-1215
Mailing Address - Fax:888-326-5817
Practice Address - Street 1:133 COLAPARCHEE CT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-7226
Practice Address - Country:US
Practice Address - Phone:478-972-0277
Practice Address - Fax:888-326-5817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000757831FMedicaid
GAG60352Medicare UPIN
GA11BDVKRMedicare ID - Type UnspecifiedMEDICARE