WEST ATLANTA PRIMARY CARE NPI 1629724752

NPI Information

  • NPI: 1629724752
  • Provider Name: WEST ATLANTA PRIMARY CARE
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • CLIA Number: 11D2265870
  • Address: 4904 TIMBER RIDGE DR STE 102
    DOUGLASVILLE, GA
    ZIP 30135
  • Phone: (678) 521-0935

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NPI Details

WEST ATLANTA PRIMARY CARE is a primary care clinic center in Douglasville, GA. WEST ATLANTA PRIMARY CARE NPI is 1629724752. The provider is registered as an organization entity type.

The provider's business location address is:

4904 TIMBER RIDGE DR STE 102
DOUGLASVILLE, GA
ZIP 30135-831
Phone: (678) 521-0935

The provider's authorized official is Shivam Desai .
The authorized official title is Owner and has the following contact phone number (678) 401-4597.

The CLIA number assigned to this NPI record is 11D2265870 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/28/2022 and was last updated on 3/25/2023.

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
1261QP2300XClinic/CenterPrimary CareYes

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: 11/21/2025

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