Healthcare Provider Details

I. General information

NPI: 1386635852
Provider Name (Legal Business Name): PRIMARY CARE GROUP OF WEST GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PROFESSIONAL PL SUITE 204
CARROLLTON GA
30117-3874
US

IV. Provider business mailing address

100 PROFESSIONAL PL STE 204
CARROLLTON GA
30117-3802
US

V. Phone/Fax

Practice location:
  • Phone: 770-834-3351
  • Fax: 770-838-1722
Mailing address:
  • Phone: 770-834-3351
  • Fax: 770-838-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: RODNEY P SMITH
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 770-838-1570