Healthcare Provider Details

I. General information

NPI: 1225041247
Provider Name (Legal Business Name): WEST END MEDICAL CENTERS, THE FAMILY HEALTH CENTER @ BOLTON VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 BOLTON RD NW SUITE 104
ATLANTA GA
30318-1137
US

IV. Provider business mailing address

868 YORK AVE SW
ATLANTA GA
30310-2750
US

V. Phone/Fax

Practice location:
  • Phone: 404-752-1400
  • Fax: 404-756-8749
Mailing address:
  • Phone: 404-752-1400
  • Fax: 404-756-8749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberNON PROFIT EXEMPT
License Number StateGA

VIII. Authorized Official

Name: DR. MICHAEL W BROOKS
Title or Position: CHIEF OPERTAING OFFICER
Credential: MD
Phone: 404-752-1400