| Oconee Primary Care, L.l.c. | |
|
1624 Mars Hill Rd Suite B Watkinsville GA 30677-4813 | |
| (404) 759-6436 | |
| (706) 769-2750 |
| Full Name | Oconee Primary Care, L.l.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1624 Mars Hill Rd, Watkinsville, Georgia |
| Authorized Official Name and Position | Ken H Park (OWNER/PROVIDER) |
| Authorized Official Contact | 4047596436 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oconee Primary Care, L.l.c. 1624 Mars Hill Rd Suite B Watkinsville GA 30677-4813 Ph: (404) 759-6436 | Oconee Primary Care, L.l.c. 1624 Mars Hill Rd Suite B Watkinsville GA 30677-4813 Ph: (404) 759-6436 |
| NPI Number | 1275860900 |
|---|---|
| Provider Enumeration Date | 11/18/2009 |
| Last Update Date | 11/18/2009 |
| Medicare PECOS PAC ID | 4981749470 |
|---|---|
| Medicare Enrollment ID | O20100309000298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275860900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 050049 (Georgia) | Primary |
| Provider Name | Ken Park |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245214402 PECOS PAC ID: 1759366016 Enrollment ID: I20040621001521 |
| Provider Name | Mary M Kim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902880123 PECOS PAC ID: 7618952987 Enrollment ID: I20040621001560 |
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