Organization
PRIMARY CARE GROUP OF WEST GEORGIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TREBBA PUTNAM (ADMINISTRATOR)
(770) 834-3351
Entity
Organization
Contact information
Practice address
100 PROFESSIONAL PL, SUITE 204, CARROLLTON, GA 30117-3874
(770) 834-3351
(770) 838-1722
Mailing address
100 PROFESSIONAL PL, SUITE 204, CARROLLTON, GA 30117-3874
(770) 834-3351
(770) 838-1722
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA9972
RAIL ROAD MEDICARE
GA
Enumeration date
11/02/2005
Last updated
04/04/2008
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