Provider Demographics
NPI:1598005829
Name:GEORGIA HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:GEORGIA HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-824-7880
Mailing Address - Street 1:127 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 720
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-1810
Mailing Address - Country:US
Mailing Address - Phone:404-490-4128
Mailing Address - Fax:
Practice Address - Street 1:127 PEACHTREE ST NE
Practice Address - Street 2:SUITE 720
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1810
Practice Address - Country:US
Practice Address - Phone:404-490-4128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA33248618AOtherMEDICARE