Healthcare Provider Details

I. General information

NPI: 1558646380
Provider Name (Legal Business Name): OCONEE COMMUNITY SERVICE BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BOLAND CIR
SPARTA GA
31087-2007
US

IV. Provider business mailing address

PO BOX 1827
MILLEDGEVILLE GA
31059-1827
US

V. Phone/Fax

Practice location:
  • Phone: 706-444-1037
  • Fax: 706-444-1034
Mailing address:
  • Phone: 478-445-4971
  • Fax: 478-445-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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