=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326553090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST GEORGIA HOME MEDICAL EQUIPMENT CO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2017
-----------------------------------------------------
Last Update Date | 11/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1861 ROANOKE RD STE A
-----------------------------------------------------
City | LAGRANGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30240-3850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-350-4200
-----------------------------------------------------
Fax | 706-350-4220
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 972
-----------------------------------------------------
City | LAGRANGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30241-0017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-350-4200
-----------------------------------------------------
Fax | 706-350-4220
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PERRY PATRICK PRATHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-350-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHRE010402
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------