Organization Active NPI

Lake Oconee Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Greensboro, GA
National Provider Identifier
1508637349
Registry record updated Jul 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
LAKE OCONEE ORTHOPEDICS, LLC
Practice address
1000 Cowles Clinic Way Ste Cy100
Greensboro, GA 30642-5285
Phone
(706) 341-4886
Fax
(706) 932-8222
NPI assigned
Jan 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2026

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

Authorized official

Name
Nyleen I Flores
Title
Chief Administrative Officer
Phone
(706) 341-4886

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

1000 Cowles Clinic Way Ste Cy100
Greensboro, GA 30642-5285

Mailing address

6350 Lake Oconee Pkwy Ste 110-61
Greensboro, GA 30642-6433
Phone (706) 341-4886

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240307003124 GA Part B Supplier - Clinic/Group Practice 2264878677 Receives reassigned benefits from 1 practitioner
Practice locations: Greensboro, GA
O20250304000026 GA DME Supplier - Physician - Orthopedic/Orthopedic Surgery 2264878677 Practice locations: Greensboro, GA

National Provider Directory

National Provider Directory

Locations

1000 Cowles Clinic Way
Ste CY100
Greensboro, GA 30642
Phone (706) 341-4886

1000 Cowles Clinic Way
Ste C-300
Greensboro, GA 30642
Phone (706) 229-8033

6350 Lake Oconee Pkwy
Ste 11061
Greensboro, GA 30642

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1704844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782864000000",
    "number": "1508637349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6350 LAKE OCONEE PKWY STE 110-61",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306426433",
            "telephone_number": "706-341-4886",
            "fax_number": "706-932-8222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 COWLES CLINIC WAY STE CY100",
            "city": "GREENSBORO",
            "state": "GA",
            "postal_code": "306425285",
            "telephone_number": "706-341-4886",
            "fax_number": "706-932-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE OCONEE ORTHOPEDICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-10",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "NYLEEN",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "706-341-4886"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.