Organization
OCONEE COMMUNITY SERVICE BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA SMITH (BILLING SUPERVISOR)
(478) 445-4817
Entity
Organization
Contact information
Practice address
1239 ORCHARD HILL RD, MILLEDGEVILLE, GA 31061-2549
(478) 445-4721
(478) 445-4693
Mailing address
PO BOX 1827, MILLEDGEVILLE, GA 31059-1827
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000604469N
—
GA
05
—
000611223A
—
GA
01
—
GRP1997
MEDICARE CROSS OVER GROUP
GA
01
—
GRP2030
MEDICARE CROSS OVER GROUP
GA
Enumeration date
05/08/2008
Last updated
03/03/2026
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