Provider Demographics
NPI:1518339795
Name:HEALING HANDS COMMUNITY CLINIC, INC
Entity Type:Organization
Organization Name:HEALING HANDS COMMUNITY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERI ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:706-781-7957
Mailing Address - Street 1:PO BOX 2143
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-2143
Mailing Address - Country:US
Mailing Address - Phone:706-994-6768
Mailing Address - Fax:706-781-3921
Practice Address - Street 1:64 BRACKETTS WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-2982
Practice Address - Country:US
Practice Address - Phone:706-994-6768
Practice Address - Fax:706-781-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN057830261QC1500X, 261QD0000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health