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General NPI Number Information
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NPI Number | 1356689806
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Entity Type | Organization
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Legal Business Name | WEST ATLANTA INTERNAL MEDICINE PC
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Dates
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Enumeration Date | 01/17/2013
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 6128 PRESTLEY MILL RD SUITE G
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5621
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Country | US
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Telephone | 770-942-6903
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Fax | 770-942-6908
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Provider Business Mailing Address
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Address Line | 6128 PRESTLEY MILL RD SUITE G
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5621
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Country | US
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Telephone | 770-942-6903
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Fax | 770-942-6908
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | DR. JOHN ALEXANDER JOHNSON
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Credential | MD
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Telephone | 770-942-6903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 046866
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License Number State | GA
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