Provider Demographics
NPI:1508637349
Name:LAKE OCONEE ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:LAKE OCONEE ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-580-8735
Mailing Address - Street 1:6350 LAKE OCONEE PKWY STE 110-61
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-6433
Mailing Address - Country:US
Mailing Address - Phone:706-341-4886
Mailing Address - Fax:706-932-8222
Practice Address - Street 1:1000 COWLES CLINIC WAY STE C-300
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-5288
Practice Address - Country:US
Practice Address - Phone:706-341-4886
Practice Address - Fax:706-932-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty