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NPI Code Detail

MEDICARE: GEORGIA HIGHLANDS MEDICAL SERVICES, INC.

MEDICARE: GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QU0200XUrgent Care Clinic/Center
2261QF0400XFederally Qualified Health Center (FQHC)GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063419422
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
Provider Business Mailing Address
First Line : PO BOX 307
Second Line :
City : CUMMING
State : GA
Zip : 30028-0307
Country : US
Telephone Number : 678-807-1050
Fax Number : 678-807-1055
Provider Business Practice Location Address
First Line : 220 OAKSIDE LN
Second Line :
City : CANTON
State : GA
Zip : 30114-6413
Country : US
Telephone Number : 678-807-1050
Fax Number : 678-807-1055
Authorized Official
Title or Position : CFO
Name : MR. STEPHEN BROWN
Credential :
Telephone Number : 770-887-1668
Provider Enumeration Date : 06/30/2005
Last Update Date : 07/21/2022

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