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NPI Code Detail

MEDICARE: PRIMARY CARE GROUP OF WEST GEORGIA

MEDICARE: PRIMARY CARE GROUP OF WEST GEORGIA
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
1207RP1001XPulmonary Disease Physician
2207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CA9972OTHERGARAIL ROAD MEDICARE

General Provider Information

NPI Number : 1386635852
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMARY CARE GROUP OF WEST GEORGIA
Provider Business Mailing Address
First Line : 100 PROFESSIONAL PL
Second Line : SUITE 204
City : CARROLLTON
State : GA
Zip : 30117-3874
Country : US
Telephone Number : 770-834-3351
Fax Number : 770-838-1722
Provider Business Practice Location Address
First Line : 100 PROFESSIONAL PL
Second Line : SUITE 204
City : CARROLLTON
State : GA
Zip : 30117-3874
Country : US
Telephone Number : 770-834-3351
Fax Number : 770-838-1722
Authorized Official
Title or Position : ADMINISTRATOR
Name : MRS. TREBBA PUTNAM
Credential :
Telephone Number : 770-834-3351
Provider Enumeration Date : 11/02/2005
Last Update Date : 04/04/2008

Similar Medicare Providers

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Practice Location Address:
100 PROFESSIONAL PL , STE 104
CARROLLTON, GA
30117-3874
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Practice Fax: 770-830-7149
1356341614 — DR. GUY HARRIS LANGLO DPM
Practice Location Address:
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1932190535 — DR. JOSEPH JELLICORSE M.D.
Practice Location Address:
100 PROFESSIONAL PARK , SUITE 204
CARROLLTON, GA
30117-3874
Practice Phone: 770-834-3351
Practice Fax:
1295726867 — DR. JACK CREWS M.D.
Practice Location Address:
100 PROFESSIONAL PL , SUITE 204
CARROLLTON, GA
30117-3874
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Practice Fax:
1184615759 — DR. HERMOGENES PAGSISIHAN M.D.
Practice Location Address:
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1467404871 — LINDSEY BASKIN ROENIGK MD
Practice Location Address:
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Practice Fax:

Directions to “PRIMARY CARE GROUP OF WEST GEORGIA ” Practice Location

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