Provider Demographics
NPI:1609928472
Name:OCONEE PEDIATRICS
Entity Type:Organization
Organization Name:OCONEE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:864-882-7800
Mailing Address - Street 1:15579 WELLS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-4318
Mailing Address - Country:US
Mailing Address - Phone:864-882-7800
Mailing Address - Fax:864-882-5908
Practice Address - Street 1:15579 WELLS HIGHWAY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4318
Practice Address - Country:US
Practice Address - Phone:864-882-7800
Practice Address - Fax:864-882-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1164Medicaid