Basic Information
Provider Information
NPI: 1992910210
EntityType: 2
ReplacementNPI:  
OrganizationName: OCONEE PHYSICIAN PRACTICES
LastName:  
FirstName:  
MiddleName:  
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Credential:  
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Mailing Information
Address1: PO BOX 601082
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282601082
CountryCode: US
TelephoneNumber: 8648857633
FaxNumber: 8648857867
Practice Location
Address1: 301 MEMORIAL DR
Address2: SUITE G
City: SENECA
State: SC
PostalCode: 296729491
CountryCode: US
TelephoneNumber: 8648857633
FaxNumber: 8648857867
Other Information
ProviderEnumerationDate: 05/11/2007
LastUpdateDate: 03/05/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WARD
AuthorizedOfficialFirstName: JEANNE
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: PRESIDENT, CEO
AuthorizedOfficialTelephone: 8648857191
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171W00000X  Y193200000X MULTI-SPECIALTY GROUPOther Service ProvidersContractor 

ID Information
IDTypeStateIssuerDescription
GP469705SC MEDICAID


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