Provider Demographics
NPI:1558646380
Name:OCONEE COMMUNITY SERVICE BOARD
Entity Type:Organization
Organization Name:OCONEE COMMUNITY SERVICE BOARD
Other - Org Name:NEW BEGINNING
Other - Org Type:Other Name
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:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-1827
Mailing Address - Country:US
Mailing Address - Phone:478-445-4971
Mailing Address - Fax:478-445-2245
Practice Address - Street 1:75 BOLAND CIR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:GA
Practice Address - Zip Code:31087-2007
Practice Address - Country:US
Practice Address - Phone:706-444-1037
Practice Address - Fax:706-444-1034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCONEE COMMUNITY SERVICE BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-12
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000604469AIMedicaid
GA202G709158OtherMEDICARE PTAN
GA000604469EMedicaid