| Highland Rivers Paulding Office | |
|
126 Enterprise Path Suite #202 Hiram GA 30141-2656 | |
| (678) 567-0920 | |
| (678) 567-0950 |
| Full Name | Highland Rivers Paulding Office |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 126 Enterprise Path, Hiram, Georgia |
| Authorized Official Name and Position | Melanie Dallas (CEO) |
| Authorized Official Contact | 7062705000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Highland Rivers Paulding Office 1503 N Tibbs Rd Ste 1 Dalton GA 30720-2915 Ph: (706) 270-5033 | Highland Rivers Paulding Office 126 Enterprise Path Suite #202 Hiram GA 30141-2656 Ph: (678) 567-0920 |
| NPI Number | 1578626917 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 11/04/2022 |
| Certification Date | 11/04/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578626917 | NPI | - | NPPES |
| 10064018 | Other | GA | AMERIGROUP PROVIDER ID |
| 000759448Q | Medicaid | GA | |
| 815526000 | Other | GA | MAGELLAN BEHAVIORAL HEALTH ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Georgia) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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