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
1241 ORCHARD HILL RD, MILLEDGEVILLE, GA 31061-2549
(478) 445-4971
Mailing address
131 N JEFFERSON ST NE, MILLEDGEVILLE, GA 31061-5513
(478) 445-4817
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00604469D
—
GA
01
—
55002141A
MEDICARE CROSS OVER
GA
01
—
GRP1997
MEDICARE PROVIDER NUMBER
GA
Enumeration date
01/09/2008
Last updated
07/21/2022
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