Provider Demographics
NPI:1679769640
Name:OCONEE COMMUNITY SERVICE BOARD
Entity Type:Organization
Organization Name:OCONEE COMMUNITY SERVICE BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE SYSTEMS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-445-4971
Mailing Address - Street 1:101 EAST SUMPTER
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024
Mailing Address - Country:US
Mailing Address - Phone:706-485-6573
Mailing Address - Fax:
Practice Address - Street 1:101 EAST SUMPTER
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024
Practice Address - Country:US
Practice Address - Phone:706-485-6573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1997OtherMEDICARE PROVIDER NUMBER
GA55002141AOtherMEDICARE CROSS OVER
GAGRP1997OtherMEDICARE PROVIDER NUMBER