Provider Demographics
NPI:1265702013
Name:GEORGIA MOUNTAIN COMMUNITY SVCS
Entity type:Organization
Organization Name:GEORGIA MOUNTAIN COMMUNITY SVCS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:EVIE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-513-5736
Mailing Address - Street 1:129 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-1123
Mailing Address - Country:US
Mailing Address - Phone:706-348-4060
Mailing Address - Fax:706-348-4079
Practice Address - Street 1:4331 THURMOND TANNER PKWY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-2829
Practice Address - Country:US
Practice Address - Phone:678-513-5700
Practice Address - Fax:678-513-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty