Provider Demographics
NPI:1073005138
Name:LAKE OCONEE WELLNESS ASSOCIATES LLC
Entity Type:Organization
Organization Name:LAKE OCONEE WELLNESS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-614-0828
Mailing Address - Street 1:1171 LAUREL POINTE
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7559
Mailing Address - Country:US
Mailing Address - Phone:706-614-0828
Mailing Address - Fax:
Practice Address - Street 1:1741 HOG MOUNTAIN RD # 200
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-1947
Practice Address - Country:US
Practice Address - Phone:706-705-6152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty