Organization
SOUTHERN HEALTH CORP OF ELLIJAY
Active
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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