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Organization
WESTCARE VILLA RICA PEDIATRICS
Active
Organization
WESTCARE VILLA RICA PEDIATRICS
Active
Other names
Westcare Pediatrics and Adult Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA MAXWELL (OFFICE MANAGER)
(770) 832-2005
Entity
Organization
Contact information
Practice address
626 DALLAS HWY, VILLA RICA, GA 30180-1209
(770) 459-9378
(770) 459-8613
Mailing address
626 DALLAS HWY, VILLA RICA, GA 30180-1209
(770) 459-9378
(770) 459-8613
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203686572A
MEDICAID PAYEE NUMBER
GA
Enumeration date
10/11/2006
Last updated
05/15/2012
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