Provider Demographics
NPI:1124329628
Name:GAINES, OSCAR CORNELL
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:CORNELL
Last Name:GAINES
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:OSCAR
Other - Middle Name:CORNELL
Other - Last Name:GAINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3200 COMMODORE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-2606
Mailing Address - Country:US
Mailing Address - Phone:478-742-3215
Mailing Address - Fax:478-742-3215
Practice Address - Street 1:1380 DOGWOOD DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5039
Practice Address - Country:US
Practice Address - Phone:615-327-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030410174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist