| Highlands Medical Plaza | |
|
475 Tribble Gap Rd Cumming GA 30040-2478 | |
| (770) 887-1668 | |
| (770) 781-9937 |
| Full Name | Highlands Medical Plaza |
|---|---|
| Speciality | Clinic/Center |
| Location | 475 Tribble Gap Rd, Cumming, Georgia |
| Authorized Official Name and Position | Todd Shifflet (CEO) |
| Authorized Official Contact | 7708871668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Highlands Medical Plaza Po Box 307 Cumming GA 30028-0307 Ph: (770) 887-1668 | Highlands Medical Plaza 475 Tribble Gap Rd Cumming GA 30040-2478 Ph: (770) 887-1668 |
| NPI Number | 1407306418 |
|---|---|
| Provider Enumeration Date | 10/13/2016 |
| Last Update Date | 05/09/2022 |
| Medicare PECOS PAC ID | 5890682017 |
|---|---|
| Medicare Enrollment ID | O20161215000918 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407306418 | NPI | - | NPPES |
| GRP1700 | Other | GA | MEDICARE PIN |
| 003183795A | Medicaid | GA | |
| 300022400A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
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