| Organization Name: | GEORGIA MOUNTAINS HEALTH SERVICES, INC |
| NPI Number: | 1285057281 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVEN MIRACLE (CEO) |
| Mailing Address: | 134 Ansley Dr Suite 200 Dahlonega |
| State: | GA US |
| Postal Code: | 305331640 |
| Phone Number: | 7068642155 |
| Fax Number: | 7063747628 |
| NPI Enumeration Date: | 01/27/2014 |
| NPI Last Update Date: | 09/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |