Healthcare Provider Details

I. General information

NPI: 1780120188
Provider Name (Legal Business Name): MOUNTAINTOP HEALTHCARE CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 MAIN ST E STE C
SNELLVILLE GA
30078-6460
US

IV. Provider business mailing address

3600 DALLAS HWY SW STE 230 PMB 156
MARIETTA GA
30064-1685
US

V. Phone/Fax

Practice location:
  • Phone: 470-395-3618
  • Fax: 770-979-5155
Mailing address:
  • Phone: 470-395-3618
  • Fax: 770-979-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number66224
License Number StateGA

VIII. Authorized Official

Name: BELINDA MILLINGTON
Title or Position: CEO
Credential: MD
Phone: 470-395-3618