Provider Demographics
NPI:1073616058
Name:OCONEE G.I. CLINIC
Entity Type:Organization
Organization Name:OCONEE G.I. CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-882-5933
Mailing Address - Street 1:PO BOX 2020
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29679-2020
Mailing Address - Country:US
Mailing Address - Phone:864-882-5933
Mailing Address - Fax:864-885-9404
Practice Address - Street 1:12 BOARDWALK PL
Practice Address - Street 2:SUITE 1A
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2671
Practice Address - Country:US
Practice Address - Phone:864-882-5933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4418Medicare PIN