Provider Demographics
NPI:1548798887
Name:ONESOURCE HEALTHCARE GROUP, LLC
Entity type:Organization
Organization Name:ONESOURCE HEALTHCARE GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-439-1950
Mailing Address - Street 1:701 N SLAPPEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1413
Mailing Address - Country:US
Mailing Address - Phone:229-439-1950
Mailing Address - Fax:229-439-1951
Practice Address - Street 1:406 S WEST ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-3918
Practice Address - Country:US
Practice Address - Phone:229-246-6417
Practice Address - Fax:229-246-2014
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONESOURCE HEALTHCARE GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058914332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies