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NPI Code Detail

MEDICARE: GEORGIA MOUNTAINS HEALTH SERVICES, INC.

MEDICARE: GEORGIA MOUNTAINS HEALTH 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)

Other Identifiers

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

General Provider Information

NPI Number : 1538123666
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGIA MOUNTAINS HEALTH SERVICES, INC.
Provider Business Mailing Address
First Line : 165 BLUE RIDGE OVERLOOK
Second Line :
City : BLUE RIDGE
State : GA
Zip : 30513-4431
Country : US
Telephone Number : 706-946-5608
Fax Number : 706-374-7628
Provider Business Practice Location Address
First Line : 165 BLUE RIDGE OVERLOOK
Second Line :
City : BLUE RIDGE
State : GA
Zip : 30513-4431
Country : US
Telephone Number : 706-946-4647
Fax Number : 706-374-5006
Authorized Official
Title or Position : CEO
Name : STEVEN MIRACLE
Credential :
Telephone Number : 706-946-5610
Provider Enumeration Date : 04/14/2006
Last Update Date : 03/11/2025

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