Organization
OCONEE COMMUNITY SERVICE BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER B GHEESLING (BILLING MANAGER)
(478) 445-4971
Entity
Organization
Contact information
Practice address
2 PINE KNOLL DR SE, MILLEDGEVILLE, GA 31061-4810
(478) 445-5255
Mailing address
PO BOX 1827, MILLEDGEVILLE, GA 31059-1827
(478) 445-4817
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00604469Z
—
GA
01
—
815926000
MAGELLAN MIS NUMBER
GA
Enumeration date
01/09/2008
Last updated
03/04/2020
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