Provider Demographics
NPI:1346553385
Name:NORTH GEORGIA HEALTHCARE SUMMERVILLE
Entity type:Organization
Organization Name:NORTH GEORGIA HEALTHCARE SUMMERVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-935-6442
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-0729
Mailing Address - Country:US
Mailing Address - Phone:706-935-6442
Mailing Address - Fax:706-935-6441
Practice Address - Street 1:11638 HIGHWAY 27
Practice Address - Street 2:#8
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-8514
Practice Address - Country:US
Practice Address - Phone:706-857-2133
Practice Address - Fax:706-935-6441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH GEORGIA HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G701165Medicare PIN