Healthcare Provider Details

I. General information

NPI: 1427233386
Provider Name (Legal Business Name): OCONEE COMMUNITY SERVICE BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 IRWINTON RD
MILLEDGEVILLE GA
31061-4704
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. DEBRA WEAVER
Title or Position: OFFICE MANAGER SYSTEMS
Credential:
Phone: 478-445-4971