PROFESSIONAL RESOURCES MANAGEMENT OF RABUN, LLC (NPI# 1326191180) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326191180 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL RESOURCES MANAGEMENT OF RABUN, LLC |
| Other Organization Name | MOUNTAIN LAKES MEDICAL CENTER |
| Practice Address |
162 Legacy Pt Clayton GA 30525-5354 |
| Practice Telephone | 7067820401 |
| Practice Fax Number | 7067820451 |
| Mailing Telephone | 7067823100 |
| Mailing Fax Number | 7067826897 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2019-10-09 |
| Authorized Official Name | TRACY LEE (BUSINESS OFFICE DIRECTOR) |
| Authorized Official Telephone | 7067820408 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
119-621 | GA | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | AMERIGROUP | 10063437 | 01 |
| GA | 0001559S | 05 | |
| GA | 00001559A | 05 | |
| GA | WELLCARE | 293932 | 01 |
| GA | BLUE CROSS OF GEORGIA | 51000340 | 01 |
| Other Name | Type Code |
|---|---|
| MOUNTAIN LAKES MEDICAL CENTER | Doing Business As Name - Organization |
| Street Address |
162 LEGACY PT |
| City | CLAYTON |
| State | GA |
| Zip Code | 30525-5354 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861980369 | Rodney Burris | Pharmacist | 162 Legacy Pt, Clayton, GA 30525-5354 | 2018-04-30 |
| 1669986295 | Lisa M Ferraro | Pharmacist | 162 Legacy Pt, Clayton, GA 30525-5354 | 2017-11-17 |
| 1447605936 | Paul Woody | Family Medicine | 162 Legacy Pt, Clayton, GA 30525-5354 | 2016-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528605839 | Charlotte Hart Fandrich | Massage Therapist | 1048 Old Highway 441 North, Clayton, GA 30525 | 2019-12-05 |
| 1922577147 | Suzanne A Frederickson | Speech-Language Pathologist | Highlands Internal Medicine, PC, 156 North Main St, Clayton, GA 30525 | 2018-11-16 |
| 1427562750 | Second Nature Blue Ridge, LLC | Psychiatric Residential Treatment Facility | 236 File St., Clayton, GA 30525 | 2017-11-22 |
| 1053854752 | Haley Vaughan Stapleton | Nurse Practitioner | 596 Mountain City Road, Clayton, GA 30525 | 2016-11-29 |
| 1154870533 | Life Point Medical, LLC | Clinic/Center | 189 Bo James Street, Suite 105, Clayton, GA 30525 | 2016-09-27 |
| 1316239122 | Jason A Bonner | Pharmacist | 1455 U.S. 441, Clayton, GA 30525 | 2011-05-11 |
| 1477842557 | Clayton Therapy Center, LLC | Marriage & Family Therapist | 24 Chechero St, Suite 2, Clayton, GA 30525 | 2011-03-29 |
| 1891959672 | Adams Hearing Aid Specialists | Hearing Instrument Specialist | 91 E Savannah Place, Clayton, GA 30525 | 2008-07-11 |
| 1578721494 | Lawrence M Gillespie | Dentist | 436 Warwoman Road, Clayton, GA 30525 | 2008-05-28 |
| 1336262112 | Clayton Family Eye Care PC | Optometrist | 50 Earl St., Suite A, Clayton, GA 30525 | 2007-04-09 |
| Find all providers in zip 30525 | ||||
| Taxonomy Code | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427051002 | Clayton Health Systems Inc | General Acute Care Hospital | 300 Wilson Street, Clayton, NM 88415-0489 | 2005-05-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780046425 | Rasheeda Brown | General Acute Care Hospital | 362 E.g. Miles Parkway, Hinesville, GA 31310-0919 | 2016-03-22 |
| 1073927117 | Polk Medical Center, Inc | General Acute Care Hospital | 2360 Rockmart Hwy, Cedartown, GA 30125-6029 | 2014-06-17 |
| 1174800114 | Emory University Hospital | General Acute Care Hospital | 1355 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2011-11-04 |
| 1013211564 | Grady Health System | General Acute Care Hospital | 180 Victoria Dr, Fayetteville, GA 30214-1163 | 2010-12-26 |
| 1417264292 | Angela Marie Barco | General Acute Care Hospital | 3486 Peach Orchard Rd Ste 200, Augusta, GA 30906 | 2010-09-01 |
| 1780880583 | Wheeler County Hospital | General Acute Care Hospital | 111 North 3rd Street, Glenwood, GA 30428 | 2007-06-27 |
| 1609078047 | Medical College of Georgia | General Acute Care Hospital | 1120 15th St # Baa-5407, Augusta, GA 30912-0004 | 2007-06-05 |
| 1982821971 | Carl Vison Va Medical Center | General Acute Care Hospital | 48 Blueberry Farm Road, Adrian, GA 31002 | 2007-04-19 |
| 1184771586 | Lower Oconee Community Hospital Inc | General Acute Care Hospital | 111 N 3rd Street, P O Bx 398, Glenwood, GA 30428 | 2007-01-05 |
| 1558423202 | Preferred Anesthesia Consultants | General Acute Care Hospital | 306 E 2nd Ave, Rome, GA 30161-3222 | 2006-12-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.