West Atlanta Primary Care | |
4904 Timber Ridge Dr Ste 102 Douglasville GA 30135-1831 | |
(678) 521-0935 | |
Not Available |
Full Name | West Atlanta Primary Care |
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Speciality | Clinic/Center |
Location | 4904 Timber Ridge Dr Ste 102, Douglasville, Georgia |
Authorized Official Name and Position | Shivam Desai (OWNER) |
Authorized Official Contact | 6784014597 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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West Atlanta Primary Care 4904 Timber Ridge Dr Ste 102 Douglasville GA 30135-1831 Ph: (678) 521-0935 | West Atlanta Primary Care 4904 Timber Ridge Dr Ste 102 Douglasville GA 30135-1831 Ph: (678) 521-0935 |
NPI Number | 1629724752 |
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Provider Enumeration Date | 02/28/2022 |
Last Update Date | 03/25/2023 |
Medicare PECOS PAC ID | 6507253465 |
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Medicare Enrollment ID | O20220422000839 |
Identifier | Type | State | Issuer |
---|---|---|---|
1629724752 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Shivam Desai |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1528591716 PECOS PAC ID: 2961776067 Enrollment ID: I20200418000278 |
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