Provider Demographics
NPI:1407306418
Name:GEORGIA HIGHLANDS MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:GEORGIA HIGHLANDS MEDICAL SERVICES, INC
Other - Org Name:HIGHLANDS MEDICAL PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIFFLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-887-1668
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-0307
Mailing Address - Country:US
Mailing Address - Phone:770-887-1668
Mailing Address - Fax:770-781-9937
Practice Address - Street 1:475 TRIBBLE GAP RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2478
Practice Address - Country:US
Practice Address - Phone:770-887-1668
Practice Address - Fax:770-781-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1700OtherMEDICARE PIN
GA003183795AMedicaid
GA300022400AMedicaid