Organization
PROFESSIONAL RESOURCES MANAGEMENT OF RABUN, LLC
Active
Organization
PROFESSIONAL RESOURCES MANAGEMENT OF RABUN, LLC
Active
Other names
MOUNTAIN LAKES MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY HALL (CEO)
(706) 782-0400
Entity
Organization
Contact information
Practice address
162 LEGACY PT, CLAYTON, GA 30525-5354
(706) 782-0401
(706) 782-0451
Mailing address
162 LEGACY PT, CLAYTON, GA 30525-5354
(706) 782-3100
(706) 782-6897
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
119-621
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00001559A
—
GA
05
—
0001559S
—
GA
01
—
10063437
AMERIGROUP
GA
01
—
293932
WELLCARE
GA
01
—
51000340
BLUE CROSS OF GEORGIA
GA
Enumeration date
01/18/2007
Last updated
08/08/2023
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