Healthcare Provider Details

I. General information

NPI: 1235325069
Provider Name (Legal Business Name): OCONEE COMMUNITY SERVICE BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 WASHINGTON AVE
SANDERSVILLE GA
31082-1971
US

IV. Provider business mailing address

PO BOX 1827
MILLEDGEVILLE GA
31059-1827
US

V. Phone/Fax

Practice location:
  • Phone: 478-552-8304
  • 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: JENNIFER B GHEESLING
Title or Position: BILLING MANAGER
Credential:
Phone: 478-445-4971