Basic Information
| Provider Information | |||||||||
| NPI: | 1346553385 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH GEORGIA HEALTHCARE SUMMERVILLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 729 | ||||||||
| Address2: | |||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307360729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7069356442 | ||||||||
| FaxNumber: | 7069356441 | ||||||||
| Practice Location | |||||||||
| Address1: | 11638 HIGHWAY 27 | ||||||||
| Address2: | #8 | ||||||||
| City: | SUMMERVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307478514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068572133 | ||||||||
| FaxNumber: | 7069356441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2010 | ||||||||
| LastUpdateDate: | 07/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | HUNTER | ||||||||
| AuthorizedOfficialFirstName: | MYRA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7069356442 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTH GEORGIA HEALTHCARE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.