Organization Name: | LAKE OCONEE URGENT AND SPECIALTY CARE CENTER |
NPI Number: | 1235547431 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | EDDIE RICHARDSON (PHYSICIAN/PRACTICE OWNER) |
Mailing Address: | 105 Harmony Xing Suite 3 Eatonton |
State: | GA US |
Postal Code: | 310249522 |
Phone Number: | 7064840884 |
Fax Number: | |
NPI Enumeration Date: | 07/31/2014 |
NPI Last Update Date: | 07/31/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 7235 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |