Organization
GEORGIA MOUNTAINS COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORETTA B JONES (BUSINESS ANALYST)
(678) 513-5762
Entity
Organization
Contact information
Practice address
4331 THURMON TANNER RD, FLOWERY BRANCH, GA 30542-2829
(678) 513-5762
Mailing address
3305 HUTCHINSON RD APT 16101, CUMMING, GA 30040-1500
(678) 312-2792
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
01
—
000607054BI
MEDICAID PROVIDER NUMBER
GA
Enumeration date
03/01/2010
Last updated
03/01/2010
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