Provider Demographics
NPI:1417088865
Name:HIGH MOUNTAIN HEALTHCARE, LLC
Entity Type:Organization
Organization Name:HIGH MOUNTAIN HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-745-2229
Mailing Address - Street 1:PO BOX 2239
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-2239
Mailing Address - Country:US
Mailing Address - Phone:706-745-2229
Mailing Address - Fax:706-745-0836
Practice Address - Street 1:63 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-2291
Practice Address - Country:US
Practice Address - Phone:706-745-2229
Practice Address - Fax:706-745-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
GA058650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA896443794AMedicaid
NC5906395Medicaid
GAGRP8045Medicare PIN