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General NPI Number Information
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NPI Number | 1992024301
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Entity Type | Organization
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Legal Business Name | GEORGIA MOUNTAINS COMMUNITY SERVICES
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 05/25/2010
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Provider Practice Location Address
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Address Line | 262 RIVER RUN RD
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City | LULA
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State | GA
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Zip | 30554-3818
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Country | US
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Telephone | 706-677-2458
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Fax |
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Provider Business Mailing Address
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Address Line | 4331 THURMON TANNER RD
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-2829
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Country | US
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Telephone | 678-513-5762
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Fax |
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Authorized Official
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Title or Position | BUSINESS ANALYST
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Name | LORETTA JONES
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Credential |
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Telephone | 678-513-5762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Legacy Identifiers
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Identifier #1
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Identifier Code | 000607054AR
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Identifier Type | MEDICAID
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Identifier State | GA
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 000607054AR
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Identifier Type | MEDICAID
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Identifier State | GA
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Identifier Issuer |
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