Healthcare Provider Details

I. General information

NPI: 1295922128
Provider Name (Legal Business Name): OCONEE COMMUNITY SERVICE BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 ORCHARD HILL RD
MILLEDGEVILLE GA
31061-2549
US

IV. Provider business mailing address

PO BOX 1827
MILLEDGEVILLE GA
31059-1827
US

V. Phone/Fax

Practice location:
  • Phone: 478-445-4721
  • Fax:
Mailing address:
  • Phone: 478-445-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER GHEESLING
Title or Position: OFFICE SYSTEMS MANAGER
Credential:
Phone: 478-445-4971