Organization
GEORGIA MOUNTAINS COMMUNITY SERVICES
Active
Other names
Avita Community Partners
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN R TUCKER (BILLING MANAGER)
(678) 513-5733
Entity
Organization
Contact information
Practice address
5700 FERNSIDE DR, TOCCOA, GA 30577-8942
(706) 886-6521
(678) 513-5836
Mailing address
4331 THURMON TANNER RD, FLOWERY BRANCH, GA 30542-2829
(678) 513-5733
(678) 513-5836
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000666553E
—
GA
Enumeration date
06/25/2010
Last updated
06/25/2010
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