Provider Demographics
NPI:1518667781
Name:OCONEE WHOLESOME MEDICAL LLC
Entity Type:Organization
Organization Name:OCONEE WHOLESOME MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEDSELY
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:VILA ALMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MC
Authorized Official - Phone:203-873-9206
Mailing Address - Street 1:1800 HOG MOUNTAIN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-1935
Mailing Address - Country:US
Mailing Address - Phone:706-769-8800
Mailing Address - Fax:706-769-8565
Practice Address - Street 1:1800 HOG MOUNTAIN RD STE 103
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-1935
Practice Address - Country:US
Practice Address - Phone:706-769-8800
Practice Address - Fax:706-769-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty