Provider Demographics
NPI:1386339141
Name:PROFESSIONAL RESOURCES MANAGEMENT OF RABUN LLC
Entity type:Organization
Organization Name:PROFESSIONAL RESOURCES MANAGEMENT OF RABUN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-782-0400
Mailing Address - Street 1:162 LEGACY PT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-5354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 LEGACY PT STE 200
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-5354
Practice Address - Country:US
Practice Address - Phone:706-782-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL RESOURCES MANAGEMENT OF RABUN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-07
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health