Healthcare Provider Details

I. General information

NPI: 1255400545
Provider Name (Legal Business Name): OCONEE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 ORCHARD HILL RD
MILLEDGEVILLE GA
31061-2551
US

IV. Provider business mailing address

PO BOX 1827
MILLEDGEVILLE GA
31059-1827
US

V. Phone/Fax

Practice location:
  • Phone: 478-445-3066
  • Fax:
Mailing address:
  • Phone: 478-445-5908
  • Fax: 478-445-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number005-R-0004
License Number StateGA

VIII. Authorized Official

Name: JENNIFER B GHEESLING
Title or Position: BILLING MANAGER
Credential:
Phone: 478-445-4971