Provider Demographics
NPI:1194987412
Name:GEORGIA HIGHLANDS MEDICAL SERVICES INC
Entity type:Organization
Organization Name:GEORGIA HIGHLANDS MEDICAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIFLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-887-1668
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:GA HIGHLANDS MEDSVCS, PROFESSIONAL PARK FAMILY PRA
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-0307
Mailing Address - Country:US
Mailing Address - Phone:770-887-1668
Mailing Address - Fax:770-781-9937
Practice Address - Street 1:540 DAHLONEGA ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2110
Practice Address - Country:US
Practice Address - Phone:770-887-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000192574FMedicaid
GA300022400AMedicaid
GA300022400AMedicaid