Provider Demographics
NPI:1962802108
Name:OCONEE INTERNAL MEDICINE, LLC
Entity type:Organization
Organization Name:OCONEE INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANELYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-468-4519
Mailing Address - Street 1:641 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2337
Mailing Address - Country:US
Mailing Address - Phone:478-453-0662
Mailing Address - Fax:478-452-8067
Practice Address - Street 1:641 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2337
Practice Address - Country:US
Practice Address - Phone:478-453-0662
Practice Address - Fax:478-452-8067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCONEE REGIONAL HEALTH VENTURES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty