NPIMap

Organization Active NPI

Georgia Highlands Medical Services, Inc

Doing business as Dawsonville Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Dawsonville, GA
National Provider Identifier
1124565650
Registry record updated May 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GEORGIA HIGHLANDS MEDICAL SERVICES, INC
Doing business as
Dawsonville Family Health Center
Practice address
5959 Highway 53 E
Suite 100
Dawsonville, GA 30534-9511
Phone
(770) 887-1668
Fax
(770) 781-9937
NPI assigned
Jan 23, 2017
Last updated
May 9, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
GEORGIA HIGHLANDS MEDICAL SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Todd Shifflet
Title
C.E.O.
Phone
(770) 887-1668

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

5959 Highway 53 E
Suite 100
Dawsonville, GA 30534-9511

Mailing address

PO Box 307
Cumming, GA 30028-0307
Phone (770) 887-1668

Other identifiers 2

IdentifierTypeStateIssuer
003188430AMedicaidGA
300022400AMedicaidGA

Other names 1

  • Dawsonville Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040302001307 GA Part B Supplier - Clinic/Group Practice 5890682017 Receives reassigned benefits from 26 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Canton, GA; Dawsonville, GA; Cumming, GA; Cartersville, GA; Buford, GA
O20170331000638 GA Part A Provider - Federally Qualified Health Center (FQHC) 5890682017 Practice locations: Dawsonville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124565650. Details of each certification follow.

Federally qualified health center certification: CCN 111057

Legal name
GEORGIA HIGHLANDS MEDICAL SERVICES, INC.
Doing business as
DAWSONVILLE FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 31, 2017
Last certification
Mar 31, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1979 in GA
Enrollment address
5959 Highway 53 E
Ste 100
Dawsonville, GA 30534-6288

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0256436Georgia Highlands Medical Services Inc5959 Highway 53 Est, Suite 100, Dawsonville, GA 30534Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Georgia Highlands Medic8 organizations share this tax ID, including this one
Part of
Georgia Highlands Medic

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

210 Oakside Ln
Canton, GA 30114
Phone (678) 807-1050

5959 Highway 53 E
Dawsonville, GA 30534
Phone (706) 216-2771

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Todd Shifflet Individual Corporate OfficerCeo Apr 13, 2014 100%
Corporate DirectorCeo Apr 13, 2014 100%
Stephen Brown Individual Corporate OfficerCfo Apr 19, 2017 99%
Operational/Managerial ControlCfo Apr 19, 2017 99%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Georgia Highlands Medical Services, Inc.Cumming, GA, CCN 111195 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652054400000",
    "number": "1124565650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 307",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300280307",
            "telephone_number": "770-887-1668",
            "fax_number": "770-781-9937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5959 HIGHWAY 53 E",
            "address_2": "SUITE 100",
            "city": "DAWSONVILLE",
            "state": "GA",
            "postal_code": "305349511",
            "telephone_number": "770-887-1668",
            "fax_number": "770-781-9937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA HIGHLANDS MEDICAL SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA HIGHLANDS MEDICAL SERVICES, INC",
        "enumeration_date": "2017-01-23",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A",
        "authorized_official_last_name": "SHIFFLET",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "770-887-1668",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003188430A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300022400A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dawsonville Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dawsonville Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dawsonville, GA

Sources for this page

Verify at the official NPI Registry.