Provider Demographics
NPI:1134323033
Name:OCONEE FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:OCONEE FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:EARHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-769-1100
Mailing Address - Street 1:1747 LANGFORD DR BLDG 400-105
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2670
Mailing Address - Country:US
Mailing Address - Phone:706-769-1100
Mailing Address - Fax:706-310-9847
Practice Address - Street 1:1747 LANGFORD DR BLDG 400-105
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2670
Practice Address - Country:US
Practice Address - Phone:706-769-1100
Practice Address - Fax:706-310-9847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043361207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4565Medicare ID - Type Unspecified