NPIMap

Professional Resources Management of Rabun LLC

Organization Active NPI Rural Health Clinic/Center · Clayton, GA

NPI 1386339141 · NPPES record last updated Jun 12, 2026

Key facts

NPI
1386339141
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
PROFESSIONAL RESOURCES MANAGEMENT OF RABUN LLC
Practice address
338 Stage Coach Dr
Clayton, GA 30525-3586
Phone
(706) 782-3100
NPI assigned
Apr 7, 2023
Organization subpart
Yes
Parent organization (as reported)
PROFESSIONAL RESOURCES MANAGEMENT OF RABUN LLC

Authorized official

Name
Kristy Hall
Title
Chief Executive Officer
Phone
(706) 782-0400

Other NPIs with the same Medicare PAC ID 2

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

Corporate family (same tax ID) 3

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Rural health clinic certification: CCN 118584

Legal name
PROFESSIONAL RESOURCES MANAGEMENT OF RABUN LLC
Doing business as
MOUNTAIN LAKES PHYSICIANS GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 18, 2023
Last certification
Dec 30, 2024
Ownership / control type
1A
Organization structure
LLC · Proprietary
Enrollment address
338 Stage Coach Dr
Clayton, GA 30525-3586
Related CCNs
111336

All disclosed owners & managing parties 6

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

NameRoleSinceShare
RJ Capital LLC
Organization · Herndon, VA
LLC, Holding company, For-profit, Owned by another organization or individual 		5% Or Greater Indirect Ownership Interest Jun 22, 2020 38.41%
Kristy Hall
Individual 		Corporate Officer
Ceo		 Mar 1, 2023 100%
Corporate Director
Ceo		 Mar 1, 2023 100%
W-2 Managing Employee Mar 1, 2023 100%
Operational/Managerial Control Mar 1, 2023 100%
MHL Partners LLC
Organization · Clayton, GA
Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 		5% Or Greater Direct Ownership Interest Jun 22, 2020 66%
Robert Lubin
Individual 		5% Or Greater Indirect Ownership Interest
Owner		 Jun 22, 2020 54.91%
Corporate Officer Mar 1, 2023 100%
Corporate Director Mar 1, 2023
Operational/Managerial Control Mar 1, 2023 100%
ML Healthcare LP
Organization · Herndon, VA
Created for acquisition, Holding company, For-profit, Owned by another organization or individual 		5% Or Greater Direct Ownership Interest Jun 22, 2020 34%
5% Or Greater Indirect Ownership Interest Feb 22, 2020 49.5%
Norma Sullivan
Individual 		Corporate Officer
Cfo		 Jan 1, 2025

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20230501002685 GA Part a Provider - Rural Health Clinic 1052342854 Practice locations: Clayton, GA

National Provider Directory

Tax ID family
Professional Resources (4 organizations share this tax ID)
Part of
Professional Resources

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

338 Stage Coach Dr
Clayton, GA 30525-3586

Mailing address

162 Legacy PT
Clayton, GA 30525-5354

Other names

  • Mountain Lakes Physicians Group Doing business as

Other providers in Clayton, GA

All providers in Clayton, GA · Rural Health Clinic/Center in Georgia

Sources for this page

Verify at the official NPI Registry.