MEDICARE: WEST GEORGIA MEDICAL CENTER, INC.

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	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467685784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST GEORGIA MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	1800 PARKWAY PL SE STE 500
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8237
Country	:	US
Telephone Number	:	470-956-4981
Fax Number	:	770-999-8237

Provider Business Practice Location Address
First Line	:	1400 HOGANSVILLE RD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-1422
Country	:	US
Telephone Number	:	706-882-0121
Fax Number	:	706-882-0123

Authorized Official
Title or Position	:	EVP
Name	:	MR. ANTHONY J BUDZINSKI
Credential	:
Telephone Number	:	470-644-0012

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	02/24/2020

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