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General NPI Number Information
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NPI Number | 1922103621
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Entity Type | Organization
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Legal Business Name | NEUROLOGY CENTER OF WEST GEORGIA PC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 300 MEDICAL DR SUITE 700
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City | LAGRANGE
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State | GA
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Zip | 30240-4130
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Country | US
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Telephone | 706-884-3018
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Fax | 706-884-3060
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Provider Business Mailing Address
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Address Line | 300 MEDICAL DR SUITE 700
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City | LAGRANGE
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State | GA
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Zip | 30240-4130
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Country | US
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Telephone | 706-884-3018
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Fax | 706-884-3060
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RAMONA M BALLENGER
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Credential |
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Telephone | 706-884-3018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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