Provider Demographics
NPI:1275686198
Name:GA. MTNS COMMUNITY SERVICES
Entity Type:Organization
Organization Name:GA. MTNS COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUBENOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:678-513-5707
Mailing Address - Street 1:2315 STEPHENS CIR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-1115
Mailing Address - Country:US
Mailing Address - Phone:770-536-4959
Mailing Address - Fax:
Practice Address - Street 1:2318 BROWNS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-6041
Practice Address - Country:US
Practice Address - Phone:678-207-1663
Practice Address - Fax:678-207-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0591261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCDGBMedicare ID - Type UnspecifiedPHYSICAN EXTENDER PA