Healthcare Provider Details

I. General information

NPI: 1043375025
Provider Name (Legal Business Name): JOSEPH EUGENE WEST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 JESSE JEWELL PKWY SE SUITE 500
GAINESVILLE GA
30501-3862
US

IV. Provider business mailing address

1240 JESSE JEWELL PKWY SE SUITE 500
GAINESVILLE GA
30501-3862
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-9864
  • Fax: 770-297-5023
Mailing address:
  • Phone: 770-536-9864
  • Fax: 770-297-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number55904
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number055904
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: