Organization
GEORGIA MOUNTAINS COMMUNITY SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN R TUCKER (BILLING MANAGER)
(678) 513-5733
Entity
Organization
Contact information
Practice address
915 FOX VALLEY ROAD, CLARKESVILLE, GA 30523-8207
(706) 894-3750
Mailing address
4331 THURMON TANNER RD, FLOWERY BRANCH, GA 30542-2829
(678) 513-5700
(675) 513-5836
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000607054BQ
—
GA
Enumeration date
09/08/2010
Last updated
09/08/2010
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