Provider Type Icon

PRIMARY CARE GROUP OF WEST GEORGIA NPI 1386635852


NPI Information

NPI: 1386635852
Provider Name: PRIMARY CARE GROUP OF WEST GEORGIA
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 11D0256261

Address:
100 PROFESSIONAL PL
SUITE 204
CARROLLTON, GA
ZIP 30117
Phone: (770) 834-3351
Get Directions

PRIMARY CARE GROUP OF WEST GEORGIA is a family medicine in Carrollton, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PRIMARY CARE GROUP OF WEST GEORGIA NPI is 1386635852. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

100 PROFESSIONAL PL
SUITE 204
CARROLLTON, GA
ZIP 30117-874
Phone: (770) 834-3351
Fax: (770) 838-1722

The provider's authorized official is Trebba Putnam .
The authorized official title is Administrator and has the following contact phone number (770) 834-3351.

The CLIA number assigned to this NPI record is 11D0256261 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/2/2005 and was last updated on 4/4/2008.


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
1207RP1001XInternal MedicinePulmonary DiseaseNo
2207Q00000XFamily MedicineYes

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
1CA9972OTHERGEORGIARAIL ROAD MEDICARE
2CA9972MEDICARE UPINGEORGIA
3GRP2462MEDICARE ID-TYPE UNSPECIFIEDGEORGIAMEDICARE

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.