Healthcare Provider Details

I. General information

NPI: 1306956396
Provider Name (Legal Business Name): GEORGIA MOUNTAINS COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 INTERSTATE RIDGE DR SUITE G
GAINESVILLE GA
30501-7076
US

IV. Provider business mailing address

4331 THURMOND TANNER RD
FLOWERY BRANCH GA
30542-2829
US

V. Phone/Fax

Practice location:
  • Phone: 678-207-1800
  • Fax:
Mailing address:
  • Phone: 678-513-5700
  • Fax: 678-513-5836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN R TUCKER
Title or Position: BILLING MANAGER
Credential:
Phone: 678-513-5733