Provider Demographics
NPI:1174710008
Name:OCONEE COMMUNITY SERVICE BOARD
Entity type:Organization
Organization Name:OCONEE COMMUNITY SERVICE BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-445-4817
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:478-445-4817
Mailing Address - Fax:
Practice Address - Street 1:822 GOLDEN HAWK DR
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-7034
Practice Address - Country:US
Practice Address - Phone:478-552-5215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000604469IMedicaid
GA00611223AOtherRX MEDICAID PROVIDER NUMB
GA00611223AOtherRX MEDICAID PROVIDER NUMB
GA00611223AOtherRX MEDICAID PROVIDER NUMB