Provider Demographics
NPI:1841467941
Name:OCONEE COMMUNITY SERVICE BOARD
Entity type:Organization
Organization Name:OCONEE COMMUNITY SERVICE BOARD
Other - Org Name:
Other - Org Type:
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:
Mailing Address - Fax:
Practice Address - Street 1:430 N JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2919
Practice Address - Country:US
Practice Address - Phone:478-445-4721
Practice Address - Fax:478-445-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000604469NMedicaid
GA000611223AMedicaid
GAGRP1997OtherMEDICARE CROSS OVER GROUP
GAGRP2030OtherMEDICARE CROSS OVER GROUP