Organization
SOUTHERN HEALTH CORP OF ELLIJAY
Active
Other names
North Georgia Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBBIE ANN SELF (CFO)
(706) 276-4741
Entity
Organization
Contact information
Practice address
60 OLD HIGHWAY 5 SOUTH, ELLIJAY, GA 30540-5436
(706) 276-4741
(706) 276-4645
Mailing address
PO BOX 1019, ELLIJAY, GA 30540-0013
(706) 276-4741
(706) 276-4645
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
061435
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118527
RURAL HEALTH CLINIC
GA
Enumeration date
01/15/2010
Last updated
01/28/2015
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