Organization
MIDTOWN WEST MEDICAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBALL A JOHNSON M.D. (OWNER)
(404) 817-0062
Entity
Organization
Contact information
Practice address
957 W MARIETTA ST NW, ATLANTA, GA 30318-5282
(404) 817-0062
(404) 817-0064
Mailing address
957 W MARIETTA ST NW, ATLANTA, GA 30318-5282
(404) 817-0062
(404) 817-0064
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
GA32213
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D1012816
CLIA #
GA
01
—
495960
BLUE CROSS BLUE SHIELD
GA
Enumeration date
12/15/2006
Last updated
08/29/2012
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