Healthcare Provider Details

I. General information

NPI: 1730236233
Provider Name (Legal Business Name): WEST GEORGIA PEDIATRIC PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 22ND ST
COLUMBUS GA
31904-8823
US

IV. Provider business mailing address

802 22ND STREET
COLUMBUS GA
31904-8823
US

V. Phone/Fax

Practice location:
  • Phone: 706-576-5773
  • Fax: 706-323-4247
Mailing address:
  • Phone: 706-576-5773
  • Fax: 706-323-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number022439
License Number StateGA

VIII. Authorized Official

Name: DR. DOUGLAS R MACLEOD
Title or Position: OFFICE MANAGER
Credential: M.D.
Phone: 706-576-5773