Provider Demographics
NPI:1598931321
Name:GEORGIA HIGHLANDS COLLEGE
Entity Type:Organization
Organization Name:GEORGIA HIGHLANDS COLLEGE
Other - Org Name:DENTAL HYGIENE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-295-6760
Mailing Address - Street 1:415 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3241
Mailing Address - Country:US
Mailing Address - Phone:706-295-6760
Mailing Address - Fax:
Practice Address - Street 1:415 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3241
Practice Address - Country:US
Practice Address - Phone:706-295-6760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNF000218261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADNF000218OtherSTATE DENTAL LICENSE