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General NPI Number Information
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NPI Number | 1093974578
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Entity Type | Organization
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Legal Business Name | WEST GA FAMILY MEDICINE, PC
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 1899 LAKE RD 212
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City | HIRAM
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State | GA
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Zip | 30141-2291
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Country | US
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Telephone | 770-222-5488
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Fax | 770-222-5491
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Provider Business Mailing Address
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Address Line | 1899 LAKE RD 212
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City | HIRAM
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State | GA
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Zip | 30141-2291
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Country | US
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Telephone | 770-222-5488
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Fax | 770-222-5491
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERRY NEWTON LANGFORD
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Credential | D.O.
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Telephone | 770-222-5488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 045867
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License Number State | GA
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