Healthcare Provider Details

I. General information

NPI: 1093379992
Provider Name (Legal Business Name): OGLETHORPE OF GEORGETOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HOME ST
GEORGETOWN OH
45121-1407
US

IV. Provider business mailing address

7074 GROVE RD STE 129
SPRING HILL FL
34609-8658
US

V. Phone/Fax

Practice location:
  • Phone: 937-483-4933
  • Fax:
Mailing address:
  • Phone: 352-597-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: BRENDA LEE JONES
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 352-597-5075