Oconee Primary Care, L.L.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

050049 Issued in GA

Legal business name

OCONEE PRIMARY CARE, L.L.C.

Practice address

1624 Mars Hill Rd
Suite B
Watkinsville, GA 30677-4813

Phone

(404) 759-6436

Fax

(706) 769-2750

NPI assigned

Nov 18, 2009

Last updated

Nov 18, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ken H Park, MDNPI 1245214402

Title

Owner/Provider

Phone

(404) 759-6436

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ken H. Park, M.D.

  • Internal Medicine Physician
  • Watkinsville, GA
  • NPI 1245214402
  Medicare reassignment Care Compare group NPD Authorized official
• Mary M. Kim, M.D.

  • Internal Medicine Physician
  • Watkinsville, GA
  • NPI 1902880123
  Medicare reassignment Care Compare group NPD
• Jessica Margaret Walker, DNP, FNP-C

  • Family Nurse Practitioner
  • Watkinsville, GA
  • NPI 1174350979
  NPD
• Haley Bauguss, PA-C

  • Medical Physician Assistant
  • Athens, GA
  • NPI 1093209538
  NPD (past)
• Ruth Quicke Brown, MSN, FNP-BC

  • Nurse Practitioner
  • Watkinsville, GA
  • NPI 1275916629
  NPD (past)
• Michelle M Gamblin, PA

  • Physician Assistant
  • Athens, GA
  • NPI 1619685518

  Internal Medicine

  NPD (past)
• Leah Marie Jobson, PA-C

  • Medical Physician Assistant
  • Watkinsville, GA
  • NPI 1194192732

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1258502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258502400000",
    "number": "1275860900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1624 MARS HILL RD",
            "address_2": "SUITE B",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774813",
            "telephone_number": "404-759-6436",
            "fax_number": "706-769-2750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1624 MARS HILL RD",
            "address_2": "SUITE B",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774813",
            "telephone_number": "404-759-6436",
            "fax_number": "706-769-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCONEE PRIMARY CARE, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-18",
        "last_updated": "2009-11-18",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "KEN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "404-759-6436",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "050049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oconee County Health Department
• Oconee County Health Department
• Oconee County Health Department (Oconee Co BD of HLTH)
• Oconee County School System
• Oconee Eye LLC
• Oconee Prosthetics LLC
• Oconee Regenerative PT LLC
• Oconee River Anesthesia Associates, LLC
• Oconee Roots Pharmacy, LLC
• Oconee Sleep Solutions LLC

• Internal Medicine Physician in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.