Organization
GEORGIA MOUNTAINS COMMUNITY SERVICES
Active
Other names
Avita Community Services
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR BOWERS (CFO)
(678) 513-5702
Entity
Organization
Contact information
Practice address
1901 COLUMNS DR APT 1901, GAINESVILLE, GA 30504-5954
(770) 572-8395
Mailing address
4331 THURMON TANNER RD, FLOWERY BRANCH, GA 30542-2829
(678) 513-5762
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000607054CP
—
GA
Enumeration date
06/21/2017
Last updated
06/21/2017
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