Provider Type Icon

WEST GEORGIA MEDICAL CENTER INC NPI 1558592089


NPI Information

NPI: 1558592089
Provider Name: WEST GEORGIA MEDICAL CENTER INC

Doing Business As: HEART AND VASCULAR CARE OF GEORGIA

Classification: Internal Medicine - 207RI0011X
Entity Type: Organization

Specialization: Interventional Cardiology

CLIA Number: 11D2143043

Address:
1551 DOCTORS DR
BLDG 200
LAGRANGE, GA
ZIP 30240
Phone: (706) 884-2641
Get Directions

WEST GEORGIA MEDICAL CENTER INC is an interventional cardiology internal medicine in Lagrange, GA. The provider is an area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. WEST GEORGIA MEDICAL CENTER INC NPI is 1558592089. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Heart And Vascular Care Of Georgia.

The provider's business location address is:

1551 DOCTORS DR
BLDG 200
LAGRANGE, GA
ZIP 30240-139
Phone: (706) 884-2641
Fax: (706) 884-2353

The provider's authorized official is Gerald Fulks .
The authorized official title is Pres / Ceo and has the following contact phone number (706) 882-1411.

The CLIA number assigned to this NPI record is 11D2143043 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/31/2009 and was last updated on 10/13/2009.


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
1207RC0000XInternal MedicineCardiovascular Disease057240GEORGIANo
2207RI0011XInternal MedicineInterventional Cardiology057240GEORGIAYes

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
1685223213BMEDICAIDGEORGIA
2202I061458OTHERGEORGIAMEDICARE PTAN

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.