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General NPI Number Information
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NPI Number | 1366504789
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MEDICAL SPECIALISTS, PC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 207 ADAMS DR
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City | DEMOREST
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State | GA
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Zip | 30535-4501
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Country | US
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Telephone | 706-754-5191
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Fax | 706-754-5191
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Provider Business Mailing Address
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Address Line | PO BOX 909
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City | CLARKESVILLE
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State | GA
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Zip | 30523-0016
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Country | US
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Telephone | 706-754-5191
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Fax | 706-754-1725
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | SONYA D HIX
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Credential |
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Telephone | 706-754-5191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN124242
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 26375
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 26375
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License Number State | GA
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