Basic Information
| Provider Information | |||||||||
| NPI: | 1548219710 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GEORGIA HEALTH CENTER P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4178 HIGHBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054545446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025249595 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4178 HIGHBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | GEORGIA | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054545446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025249595 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 05/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | SAFERSTEIN | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8025249595 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 1008067 | 05 | VT | MEDICAID | CJ2544 | 01 | VT | RAIL ROAD MEDICARE | OTHER |