Provider Demographics
NPI:1073549101
Name:OCONEE MEDICAL GROUP
Entity Type:Organization
Organization Name:OCONEE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER / ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-227-2110
Mailing Address - Street 1:1440 N CHASE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-1850
Mailing Address - Country:US
Mailing Address - Phone:706-227-2110
Mailing Address - Fax:706-227-2116
Practice Address - Street 1:1440 N CHASE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1850
Practice Address - Country:US
Practice Address - Phone:706-227-2110
Practice Address - Fax:706-227-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039272207RN0300X
GA046700207RN0300X
GA045379207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG79234Medicare UPIN
GA18BDGKLMedicare ID - Type Unspecified
GAG44567Medicare UPIN
GA11SCDTHMedicare ID - Type Unspecified