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Contact Information

MOUNTAIN MEDICAL SPECIALISTS, PC
207 ADAMS DR
DEMOREST, GA30535-4501
 Phone: 706-754-5191
 Fax: 706-754-5191
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Family

363LF0000X 50 Nurse Practitioner
 

Sports Medicine

207RS0010X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for MOUNTAIN MEDICAL SPECIALISTS, PC

NPI # 1366504789
LBN Legal business name MOUNTAIN MEDICAL SPECIALISTS, PC
Authorized official SONYA HIX - (OFFICE ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 12/14/2006
Last updated 03/07/2024 - About 2 years ago
Identifiers
GA License # 26375
GA License # RN124242
GA Medicaid 000300605D
GA Other 110104731 RAILROAD MEDICARE
GA Other D42109 SANDERS UPIN NUMBER
GA Other 194840 WELLCARE VENDOR NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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