MEDICARE: WEST LAKE PEDIATRICS, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	033194	GA

General Provider Information

NPI Number	:	1073668463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST LAKE PEDIATRICS, L.L.C.

Provider Business Mailing Address
First Line	:	901 FRANKLIN SPRINGS ST
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-3911
Country	:	US
Telephone Number	:	706-245-5040
Fax Number	:	706-245-6599

Provider Business Practice Location Address
First Line	:	901 FRANKLIN SPRINGS ST
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-3911
Country	:	US
Telephone Number	:	706-245-5040
Fax Number	:	706-245-6599

Authorized Official
Title or Position	:	OWNER
Name	:	MARGARET SHERMAN
Credential	:	M.D.
Telephone Number	:	706-245-5040

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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Directions to “WEST LAKE PEDIATRICS, L.L.C. ” Practice Location

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