Provider Demographics
NPI:1780621664
Name:HEALTHMONT OF GEORGIA, INC
Entity type:Organization
Organization Name:HEALTHMONT OF GEORGIA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:229-896-8177
Mailing Address - Street 1:706 N PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-1511
Mailing Address - Country:US
Mailing Address - Phone:229-896-8177
Mailing Address - Fax:229-896-7880
Practice Address - Street 1:413 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-2607
Practice Address - Country:US
Practice Address - Phone:229-896-8177
Practice Address - Fax:229-896-7880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHMONT OF GEORGIA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037-101251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00887983AMedicaid
GA117087Medicare ID - Type Unspecified