MEDICARE: GEORGIA MOUNTAINS HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1962189449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA MOUNTAINS HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	165 BLUE RIDGE OVERLOOK
Second Line	:
City	:	BLUE RIDGE
State	:	GA
Zip	:	30513-4431
Country	:	US
Telephone Number	:	706-946-5607
Fax Number	:	706-374-7628

Provider Business Practice Location Address
First Line	:	153 SCHOOL DR
Second Line	:
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-0313
Country	:	US
Telephone Number	:	706-701-5001
Fax Number	:	706-701-5002

Authorized Official
Title or Position	:	CEO
Name	:	STEVEN MIRACLE
Credential	:
Telephone Number	:	706-946-5610

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	09/19/2024

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