NPIMap

Organization Active NPI

Georgia Mountains Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chatsworth, GA
National Provider Identifier
1881050508
Registry record updated May 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GEORGIA MOUNTAINS HEALTH SERVICES, INC.
Practice address
500 Green Rd
Chatsworth, GA 30705-2745
Phone
(706) 517-2200
Fax
(706) 517-2469
NPI assigned
Jan 11, 2016
Last updated
May 4, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
GEORGIA MOUNTAINS HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 4, 2026

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

Authorized official

Name
Andrew Stewart
Title
Ceo
Phone
(706) 946-5600

Specialties & licenses 2

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

Addresses

Primary practice location

500 Green Rd
Chatsworth, GA 30705-2745

Mailing address

165 Blue Ridge Overlook
Blue Ridge, GA 30513-4431
Phone (706) 946-5607

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040429000383 GA Part B Supplier - Clinic/Group Practice 7719974831 Receives reassigned benefits from 33 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dahlonega, GA; La Fayette, GA; Ellijay, GA; Chatsworth, GA; Blue Ridge, GA
O20170417000952 GA Part A Provider - Federally Qualified Health Center (FQHC) 7719974831 Practice locations: Chatsworth, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881050508. Details of each certification follow.

Federally qualified health center certification: CCN 111058

Legal name
GEORGIA MOUNTAINS HEALTH SERVICES, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 17, 2017
Last certification
Apr 17, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 11, 2016 in GA
Enrollment address
500 Green Rd
Chatsworth, GA 30705-2745

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 6

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
11D2129920Georgia Mountains Health Service, Inc500 Green Road, Chatsworth, GA 30705Certificate of waiverJul 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Georgia Mountns HLTH11 organizations share this tax ID, including this one
Part of
Georgia Mountns HLTH

Other organizations with this tax ID 10

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

Locations

134 Ansley Dr
Ste 700
Dahlonega, GA 30533
Phone (706) 701-5001

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Steven Miracle Individual Corporate DirectorCeo Jun 12, 2003 100%
Operational/Managerial ControlCeo Jun 12, 2003 100%
Yaneth Garcia Individual Corporate DirectorBoard Member Mar 20, 2022
Marianella Crispin Individual Corporate DirectorBoard Member Sep 26, 2022
Melissa P Sneads Individual Corporate DirectorBoard Member Feb 17, 2021
Deborah S Peterson Individual Corporate DirectorBoard Member Jan 1, 2012
Randy Westbrook Individual Corporate OfficerCfo Sep 29, 2008
John H Rhodes Individual Corporate DirectorBoard Member Jul 25, 2011
Ronald Stan Bafile Individual Corporate DirectorBoard Member Mar 8, 2022
Marvin Chance Individual Corporate DirectorBoard Member Jul 6, 2018
Patricia a Hampton Individual Corporate DirectorBoard Member Apr 26, 2010
Lloyd Gamison Phillips Individual Corporate DirectorBoard Member Jan 12, 2010
Bianca Whittenbarger Individual Corporate DirectorBoard Member May 1, 2014

Practitioners & affiliated clinicians

Practitioners 12

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": "1452470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777852800000",
    "number": "1881050508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 BLUE RIDGE OVERLOOK",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305134431",
            "telephone_number": "706-946-5607",
            "fax_number": "706-374-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 GREEN RD",
            "city": "CHATSWORTH",
            "state": "GA",
            "postal_code": "307052745",
            "telephone_number": "706-517-2200",
            "fax_number": "706-517-2469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA MOUNTAINS HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA MOUNTAINS HEALTH SERVICES, INC.",
        "enumeration_date": "2016-01-11",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-946-5600"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chatsworth, GA

Sources for this page

Verify at the official NPI Registry.