1730400896 NPI number — GEORGIA MOUNTAINS COMMUNITY SERVICES

Table of content: JUDY LYNN HEIMLICH M.A., L.P. (NPI 1700938081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730400896 NPI number — GEORGIA MOUNTAINS COMMUNITY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA MOUNTAINS COMMUNITY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730400896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4331 THURMON TANNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWERY BRANCH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30542-2829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-513-5762
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5757 FORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAIRSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30512-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-745-5911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
LORETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS ANALYST
Authorized Official Telephone Number:
678-513-5762

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000666542N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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