Organization
WEST GEORGIA MEDICAL CENTER INC
Active
Parent organization
WEST GEORGIA MEDICAL CENTER, INC
Other names
HEART AND VASCULAR CARE OF GEORGIA
Organization subpart
Yes
Provider details
NPI number
Legal business name
WEST GEORGIA MEDICAL CENTER, INC
Authorized official
GERALD FULKS (PRES / CEO)
(706) 882-1411
Entity
Organization
Contact information
Practice address
1551 DOCTORS DR, BLDG 200, LAGRANGE, GA 30240-4139
(706) 884-2641
(706) 884-2353
Mailing address
PO BOX 435, LAGRANGE, GA 30241-0008
(706) 884-2641
(706) 884-2353
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
057240
GA
207RI0011X
Interventional Cardiology Physician
Primary
057240
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I061458
MEDICARE PTAN
GA
05
—
685223213B
—
GA
Enumeration date
07/31/2009
Last updated
10/13/2009
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