Provider Demographics
NPI:1932596467
Name:GEORGIA COMMUNITY CLINIC, LLC
Entity Type:Organization
Organization Name:GEORGIA COMMUNITY CLINIC, LLC
Other - Org Name:GEORGIA COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:770-282-4492
Mailing Address - Street 1:8 FRANKLIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1312
Mailing Address - Country:US
Mailing Address - Phone:470-414-2500
Mailing Address - Fax:
Practice Address - Street 1:8 FRANKLIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1312
Practice Address - Country:US
Practice Address - Phone:470-414-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008139101YP2500X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty