NPIMap

Organization Active NPI

Lake Oconee Urgent and Specialty Care Center

  • Medical Physician Assistant
  • Eatonton, GA
National Provider Identifier
1235547431
Registry record updated Jul 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
7235 Issued in GA
Legal business name
LAKE OCONEE URGENT AND SPECIALTY CARE CENTER
Practice address
105 Harmony Xing
Suite 3
Eatonton, GA 31024-9522
Phone
(706) 484-0884
NPI assigned
Jul 31, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Eddie Richardson, M.D.
Title
Physician/Practice Owner
Phone
(706) 484-0884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X 7235 GA Primary

Addresses

Primary practice location

105 Harmony Xing
Suite 3
Eatonton, GA 31024-9522

Mailing address

1881 Lancaster Dr SE
Conyers, GA 30013-6440
Phone (404) 405-7596

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406764800000",
    "number": "1235547431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1881 LANCASTER DR SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136440",
            "telephone_number": "404-405-7596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 HARMONY XING",
            "address_2": "SUITE 3",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "310249522",
            "telephone_number": "706-484-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE OCONEE URGENT AND SPECIALTY CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-31",
        "last_updated": "2014-07-31",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_title_or_position": "PHYSICIAN/PRACTICE OWNER",
        "authorized_official_telephone_number": "706-484-0884",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "7235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eatonton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.