1881899458 NPI number — OCONEE PATHOLOGY ASSOCIATES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881899458 NPI number — OCONEE PATHOLOGY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCONEE PATHOLOGY ASSOCIATES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881899458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1705
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLEDGEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31059-1705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-454-3688
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 N COBB ST
Provider Second Line Business Practice Location Address:
PATHOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
MILLEDGEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31061-2343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-454-3688
Provider Business Practice Location Address Fax Number:
478-454-3694
Provider Enumeration Date:
06/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
REGINALD
Authorized Official Middle Name:
WENDALL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
478-454-3688

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  030927 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 297058 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: DD8654 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 118365 . This is a "PEACH STATE HLT PLANS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 727301 . This is a "BCBSGA PROVIDER #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10049818 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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