GEORGIA MOUNTAINS HEALTH SERVICES, INC. (NPI# 1396940029) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396940029 |
| Entity Type | Organization |
| Organization Name | GEORGIA MOUNTAINS HEALTH SERVICES, INC. |
| Practice Address |
772 Maddox Drive Suite 122 East Ellijay GA 30540-8196 |
| Mailing Address |
165 Blue Ridge Overlook Blue Ridge GA 30513-4431 |
| Practice Telephone | 7066356898 |
| Practice Fax Number | 7066356885 |
| Mailing Telephone | 7069464647 |
| Mailing Fax Number | 7063747628 |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2020-04-22 |
| Authorized Official Name | MR. 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 | 000236519B | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124684618 | Georgia Mountains Health Services, Inc. | Clinic/Center | 4560 Old Highway 76, Blue Ridge, GA 30513-4756 | 2019-05-10 |
| 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 |
772 MADDOX DRIVE SUITE 122 |
| City | EAST ELLIJAY |
| State | GA |
| Zip Code | 30540-8196 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508223843 | Lhcg Lxxiv, LLC | Hospice Care, Community Based | 772 Maddox Drive, Suite 112, East Ellijay, GA 30540-8197 | 2016-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760929517 | Sandi Lynn Harris | Pharmacist | 192 1st St, East Ellijay, GA 30540 | 2017-01-31 |
| 1194028688 | Heartlite Hospice Ellijay, Inc. | Hospice Care, Community Based | 163 Dalton Street, East Ellijay, GA 30540 | 2010-12-06 |
| 1972816874 | Nicole Penland Bond | Nurse Practitioner | 174 Highland Crossing East, East Ellijay, GA 30540 | 2010-07-20 |
| 1689994477 | Immediate Medcare, LLC | Clinic/Center | 174 Highland Crossing South, East Ellijay, GA 30540 | 2010-06-03 |
| 1316274830 | Huffs Select Care Clinic PC | Clinic/Center | 136-a Industrial Blvd, Ellijay, GA 30540 | 2009-11-04 |
| 1598924615 | Hospice Advantage, LLC. | Hospice Care, Community Based | 583 Highland Xing, Suite 120, East Ellijay, GA 30540 | 2008-06-04 |
| 1083891196 | Roy Elie Abrahamian | Internal Medicine | 309 Highland Pkwy Ste 200, East Ellijay, GA 30540 | 2008-01-31 |
| 1285817213 | Quality Respi-care Inc | Durable Medical Equipment & Medical Supplies | 97 Hefner St Ste 102, East Ellijay, GA 30540 | 2007-12-13 |
| 1275738163 | Jennifer Moss Houle | Technician, Other | 7 Depot Street, Ellijay, GA 30540 | 2007-06-19 |
| 1265633697 | Alicia S Lovelace | Specialist | 630 Blazing Star Rd, Ellijay, GA 30540 | 2007-05-31 |
| Find all providers in zip 30540 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1366066243 | Health Education Assessment and Leadership Inc | Clinic/Center | 225 Griffin St Nw, Atlanta, GA 30314-3917 | 2020-06-05 |
| 1851924377 | Valley Healthcare System | Clinic/Center | 1458 Benning Dr, Columbus, GA 31903-2200 | 2020-02-13 |
| 1952941528 | Curtis V. Cooper Primary Health Care, Inc | Clinic/Center | 400 E Broad St, Savannah, GA 31401-5104 | 2020-01-13 |
| 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 | EAST ELLIJAY |
| Zip Code | 30540 |
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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.