Provider Demographics
NPI:1801803820
Name:CLARKE OCONEE FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:CLARKE OCONEE FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:706-353-7747
Mailing Address - Street 1:PO BOX 7336
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-7336
Mailing Address - Country:US
Mailing Address - Phone:706-353-7747
Mailing Address - Fax:706-353-7756
Practice Address - Street 1:700 SUNSET DR STE 400A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2293
Practice Address - Country:US
Practice Address - Phone:706-353-7747
Practice Address - Fax:706-353-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1467443713OtherNPI PHYSICIAN
GA169764070AMedicaid
GA169764070AMedicaid
GAF83673Medicare UPIN