Provider Demographics
NPI:1275890261
Name:GEORGIA MOUNTAIN COMMUNITY SVS
Entity Type:Organization
Organization Name:GEORGIA MOUNTAIN COMMUNITY SVS
Other - Org Name:AVITA COMMUNITY PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-513-5736
Mailing Address - Street 1:4331 THURMOND TANNER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-2829
Mailing Address - Country:US
Mailing Address - Phone:678-513-5700
Mailing Address - Fax:678-513-5836
Practice Address - Street 1:1161 OLD CARNES CREEK RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-7210
Practice Address - Country:US
Practice Address - Phone:706-894-3700
Practice Address - Fax:706-894-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services