Provider Demographics
NPI:1295275873
Name:GEORGIA MOUNTAINS COMMUNITY SERVICES
Entity type:Organization
Organization Name:GEORGIA MOUNTAINS COMMUNITY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-513-5762
Mailing Address - Street 1:4331 THURMON TANNER RD
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-2829
Mailing Address - Country:US
Mailing Address - Phone:678-513-5762
Mailing Address - Fax:678-513-5831
Practice Address - Street 1:1143 RACETRACK RD
Practice Address - Street 2:
Practice Address - City:EASTANOLLEE
Practice Address - State:GA
Practice Address - Zip Code:30538-2928
Practice Address - Country:US
Practice Address - Phone:678-513-5762
Practice Address - Fax:678-513-5831
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARENT ORGANIZATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000600795AKMedicaid