Provider Type Icon

WEST ATLANTA INTERNAL MEDICINE PC NPI 1356689806


NPI Information

NPI: 1356689806
Provider Name: WEST ATLANTA INTERNAL MEDICINE PC
Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

CLIA Number: 11D2253746

Address:
6128 PRESTLEY MILL RD
SUITE G
DOUGLASVILLE, GA
ZIP 30134
Phone: (770) 942-6903
Get Directions

WEST ATLANTA INTERNAL MEDICINE PC is a medical specialty clinic center in Douglasville, GA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). WEST ATLANTA INTERNAL MEDICINE PC NPI is 1356689806. The provider is registered as an organization entity type.

The provider's business location address is:

6128 PRESTLEY MILL RD
SUITE G
DOUGLASVILLE, GA
ZIP 30134-621
Phone: (770) 942-6903
Fax: (770) 942-6908

The provider's authorized official is John Alexander Johnson .
The authorized official title is Medical Director/owner and has the following contact phone number (770) 942-6903.

The CLIA number assigned to this NPI record is 11D2253746 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/17/2013 and was last updated on 1/28/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM2500XClinic/CenterMedical Specialty046866GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1H28136MEDICARE UPINGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.