Healthcare Provider Details

I. General information

NPI: 1811501455
Provider Name (Legal Business Name): GEORGIA HIGHLANDS MEDICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 OAKSIDE LN
CANTON GA
30114-6417
US

IV. Provider business mailing address

PO BOX 307
CUMMING GA
30028-0307
US

V. Phone/Fax

Practice location:
  • Phone: 678-807-1050
  • Fax: 770-720-7384
Mailing address:
  • Phone: 678-807-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TODD SHIFLETT
Title or Position: CEO
Credential:
Phone: 770-887-1668