| Ghm2012 Corp. | |
|
700 Sunset Dr Ste 302 Athens GA 30606-7721 | |
| (404) 775-5755 | |
| Not Available |
| Full Name | Ghm2012 Corp. |
|---|---|
| Speciality | Social Worker |
| Location | 700 Sunset Dr Ste 302, Athens, Georgia |
| Authorized Official Name and Position | Rebecca Bloomfield Kubin (OWNER) |
| Authorized Official Contact | 4047755755 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ghm2012 Corp. 2522 Parkside Dr Ne Atlanta GA 30305-3732 Ph: (404) 775-5755 | Ghm2012 Corp. 700 Sunset Dr Ste 302 Athens GA 30606-7721 Ph: (404) 775-5755 |
| NPI Number | 1245926427 |
|---|---|
| Provider Enumeration Date | 04/12/2023 |
| Last Update Date | 04/12/2023 |
| Certification Date | 04/12/2023 |
| Medicare PECOS PAC ID | 1052773330 |
|---|---|
| Medicare Enrollment ID | O20230818000132 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245926427 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Danneel A Hubbell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538347257 PECOS PAC ID: 9739312836 Enrollment ID: I20140424002093 |
| Provider Name | Shannon Bruckner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497243836 PECOS PAC ID: 9931444718 Enrollment ID: I20181226001779 |
| Provider Name | Jeremy Scott Lynn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104428705 PECOS PAC ID: 2264894302 Enrollment ID: I20230822000312 |
| Provider Name | Elizabeth L Segars |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235903618 PECOS PAC ID: 6002264967 Enrollment ID: I20231204000198 |
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