MEDICARE: MR. DEREK A WEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	PHCP011562	GA
2	372600000X	Adult Companion	PHCP011562	GA
3	163WA2000X	Administrator Registered Nurse	PHCP011562	GA
4	163WH0200X	Home Health Registered Nurse	PHCP011562	GA
5	163WP0200X	Pediatric Registered Nurse	PHCP011562	GA
6	163WW0000X	Wound Care Registered Nurse	PHCP011562	GA
7	172A00000X	Driver	PHCP011562	GA
8	374U00000X	Home Health Aide	PHCP011562	GA
9	376K00000X	Nurse's Aide	PHCP011562	GA

General Provider Information

NPI Number	:	1821734856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEREK A WEST

Provider Business Mailing Address
First Line	:	500 WINDSOR WAY
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-6446
Country	:	US
Telephone Number	:	404-786-8598
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 WINDSOR WAY
Second Line	:
City	:	FAIRBURN
State	:	GA
Zip	:	30213-6446
Country	:	US
Telephone Number	:	404-786-8598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	05/11/2022

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Directions to “ MR. DEREK A WEST ” Practice Location

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