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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