Provider Demographics
NPI:1275677098
Name:OCONEE COMMUNITY SERVICE BOARD
Entity Type:Organization
Organization Name:OCONEE COMMUNITY SERVICE BOARD
Other - Org Name:OCONEE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:GHEESLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-445-4971
Mailing Address - Street 1:1241A ORCHARD HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2549
Mailing Address - Country:US
Mailing Address - Phone:478-445-4817
Mailing Address - Fax:478-445-4963
Practice Address - Street 1:1241A ORCHARD HILL RD
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2549
Practice Address - Country:US
Practice Address - Phone:478-445-4817
Practice Address - Fax:478-445-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00605569PMedicaid
GA00604469JMedicaid
GA00604469YMedicaid
GA00603424KMedicaid
GA099987674AMedicaid
GA00603424BMedicaid
GA00603424FMedicaid
GA00604469FMedicaid
GA00604469UMedicaid
GA00925339AMedicaid
GA00604469BMedicaid
GA00604469QMedicaid
GA00604469IMedicaid
GA00604469NMedicaid
GA00604469ZMedicaid
GA00611223AMedicaid
GA16-728-5282OtherD-U-N-S
GA00604469ZMedicaid