GEORGIA MOUNTAINS HEALTH SERVICES, INC. (NPI# 1124684618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124684618 |
| Entity Type | Organization |
| Organization Name | GEORGIA MOUNTAINS HEALTH SERVICES, INC. |
| Practice Address |
4560 Old Highway 76 Blue Ridge GA 30513-4756 |
| Mailing Address |
165 Blue Ridge Overlook Blue Ridge GA 30513-4431 |
| Practice Telephone | 7069464647 |
| Practice Fax Number | 7063745006 |
| Mailing Telephone | 7069465602 |
| Mailing Fax Number | 7063747628 |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2019-05-10 |
| Authorized Official Name | STEVEN MIRACLE (CEO) |
| Authorized Official Telephone | 7069465610 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000236519A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396940029 | Georgia Mountains Health Services, Inc. | Clinic/Center | 772 Maddox Drive, Suite 122, East Ellijay, GA 30540-8196 | 2007-06-21 |
| 1225399041 | Georgia Mountains Health Services, Inc. | Clinic/Center | 218 N Fredrick St, Dalton, GA 30721-3242 | 2012-06-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | GEORGIA MOUNTAINS HEALTH SERVICES, INC. | 165 Blue Ridge Overlook, Blue Ridge, GA 30513-4431 |
| Street Address |
4560 OLD HIGHWAY 76 |
| City | BLUE RIDGE |
| State | GA |
| Zip Code | 30513-4756 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356804561 | Christine Gangwisch | Registered Nurse | 3855 Old Highway 5 Ste 110, Blue Ridge, GA 30513 | 2019-04-13 |
| 1013474659 | Ten Dental LLC | Dentist | 330 Progress Circle Ste C, Blue Ridge, GA 30513 | 2019-03-01 |
| 1932646262 | David Lee Durham | Pharmacist | 5679 Appalachian Highway, Blue Ridge, GA 30513 | 2017-01-25 |
| 1659754398 | Jordan Patton | Ophthalmology | 266 Orvin Lance Dr Ste 5, Blue Ridge, GA 30513 | 2015-06-30 |
| 1063824977 | Christy Russell | Pharmacist | 97 Commerce Drive, Blue Ridge, GA 30513 | 2014-05-27 |
| 1588008429 | Nathan William Kincaid | Surgery | 2855 Old Highway 5 Ste 108, Blue Ridge, GA 30513 | 2013-04-22 |
| 1972800175 | W. Max Couch, Jr., Dds, Mds, LLC | Dentist | 2714 East First Street, Blue Ridge, GA 30513 | 2011-02-24 |
| 1760792246 | Med-trans Corporation | Ambulance | 482 Mccaysville Industrial Dr, Blue Ridge, GA 30513 | 2010-10-18 |
| 1396924791 | Sue Ann Richardson | Chiropractor | 59 Mckinney, Blue Ridge, GA 30513 | 2007-11-01 |
| 1164554432 | Pruitthealth Home First, Inc. | Case Management | 6050 Appalachian Highway, Suite 4, Blue Ridge, GA 30513 | 2007-03-12 |
| Find all providers in zip 30513 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457849390 | Georgia Mountains Health Services. Inc. | Clinic/Center | 1600 Ballewtown Rd, Blue Ridge, GA 30513-5337 | 2018-04-26 |
| 1538123666 | Georgia Mountains Health Services, Inc | Clinic/Center | 165 Blue Ridge Overlook, Blue Ridge, GA 30513-4431 | 2006-04-14 |
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|---|---|---|---|---|
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| 1366066243 | Health Education Assessment and Leadership Inc | Clinic/Center | 225 Griffin St Nw, Atlanta, GA 30314-3917 | 2020-06-05 |
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| 1023658523 | Saint Joseph's Mercy Care Services, Inc. | Clinic/Center | 1407 Cobb Parkway Nw, Marietta, GA 30060-6546 | 2020-01-13 |
| 1467092221 | Careconnect Health, Inc. | Clinic/Center | 130 N Lee St, Forsyth, GA 31029-2122 | 2020-01-09 |
| 1417597238 | The Family Health Centers of Georgia, Inc | Clinic/Center | 19 John Maddox Dr Nw Ste B, Rome, GA 30165-1477 | 2020-01-09 |
| 1649810714 | Careconnect Health, Inc. | Clinic/Center | 254 Wright Avenue, Roberta, GA 31078 | 2020-01-07 |
| 1437798725 | Careconnect Health, Inc. | Clinic/Center | 414 S Frontage Rd Lot 53, Forsyth, GA 31029-3025 | 2020-01-03 |
| 1285277608 | Saint Joseph's Mercy Care Services, Inc. | Clinic/Center | 1976 Flat Shoals Rd Se Ste B, Atlanta, GA 30316-2857 | 2019-10-18 |
| Find all providers with the same taxonomy | ||||
| City | BLUE RIDGE |
| Zip Code | 30513 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.