Healthcare Provider Details

I. General information

NPI: 1043318355
Provider Name (Legal Business Name): LAGRANGE MED CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 VERNON ST
LAGRANGE GA
30240-3162
US

IV. Provider business mailing address

309 VERNON ST
LAGRANGE GA
30240-3162
US

V. Phone/Fax

Practice location:
  • Phone: 706-885-9110
  • Fax: 706-885-9113
Mailing address:
  • Phone: 706-885-9110
  • Fax: 706-885-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number024497
License Number StateGA

VIII. Authorized Official

Name: DR. GARY RONALD SOLT
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 706-885-9110