Provider Demographics
NPI:1780926675
Name:OCONEE PHYSICIAN PRACTICES
Entity type:Organization
Organization Name:OCONEE PHYSICIAN PRACTICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-888-4445
Mailing Address - Street 1:PO BOX 601082
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1082
Mailing Address - Country:US
Mailing Address - Phone:864-885-7989
Mailing Address - Fax:864-885-7642
Practice Address - Street 1:106 RAM CAT ALY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-3244
Practice Address - Country:US
Practice Address - Phone:864-888-4445
Practice Address - Fax:864-888-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1908261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care