Provider Demographics
NPI:1235677469
Name:GEORGIA HIGHLANDS MEDICAL SERVICES INC.
Entity Type:Organization
Organization Name:GEORGIA HIGHLANDS MEDICAL SERVICES INC.
Other - Org Name:HIGHLANDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:770-887-1670
Mailing Address - Street 1:260 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2467
Mailing Address - Country:US
Mailing Address - Phone:770-887-1670
Mailing Address - Fax:
Practice Address - Street 1:260 ELM ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2467
Practice Address - Country:US
Practice Address - Phone:770-887-1670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023733261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)