Provider Demographics
NPI:1316938459
Name:NAVICENT HEALTH OCONEE, LLC
Entity type:Organization
Organization Name:NAVICENT HEALTH OCONEE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP / ENTERPRISE CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-633-1452
Mailing Address - Street 1:821 N COBB ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2343
Mailing Address - Country:US
Mailing Address - Phone:478-766-4000
Mailing Address - Fax:478-776-4718
Practice Address - Street 1:821 N COBB ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2343
Practice Address - Country:US
Practice Address - Phone:478-776-4000
Practice Address - Fax:478-776-4718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000-587282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000046OtherBLUE CROSS
GA00000129AMedicaid
GAHOSP225Medicare ID - Type UnspecifiedMEDICARE PART B
GA00000129AMedicaid
GA=========002OtherTRICARE
GA00000129AMedicaid