Organization
CARROLL COUNTY NEUROLOGY
Active
Other names
West Georgia Sleep Disorders and Neurology Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA LEE WALKER (ADMINISTRATOR)
(770) 832-2775
Entity
Organization
Contact information
Practice address
524 DIXIE ST, CARROLLTON, GA 30117-3805
(770) 832-2775
(770) 832-9529
Mailing address
524 DIXIE ST, CARROLLTON, GA 30117-3805
(770) 832-2775
(770) 832-9529
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
040159
GA
2084N0400X
Neurology Physician
050478
GA
2084N0400X
Neurology Physician
Primary
053520
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000670909A
—
GA
05
—
000670909E
—
GA
05
—
000670909F
—
GA
05
—
000920796A
—
GA
05
—
000920796B
—
GA
05
—
000920796C
—
GA
05
—
009602420
—
AL
05
—
009981360
—
AL
01
—
130011906
R X R MEDICARE
—
01
—
130024279
R X R MEDICARE
—
01
—
13BDCK01
MEDICARE ID
—
01
—
13BDCKS
MEDICARE ID
—
01
—
13BDDKV
MEDICARE
—
01
—
13BDDKV01
MEDICARE ID
—
01
—
13BDFFB
MEDICARE ID
—
01
—
13BDFFB01
MEDICARE ID
—
01
—
506390
BSBC
—
01
—
52212528
BCBS
—
01
—
5632868
CIGNA
—
05
—
586993320E
—
GA
01
—
6941783
CIGNA
—
01
—
7357225
AETNA
—
01
—
864345
BCBS
—
Enumeration date
12/11/2006
Last updated
12/03/2009
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