| West Georgia Sports Medicine | |
|
1601 Maple St Carrollton GA 30118-0001 | |
| (678) 839-6628 | |
| (972) 367-3451 |
| Full Name | West Georgia Sports Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1601 Maple St, Carrollton, Georgia |
| Authorized Official Name and Position | Mouzon Bass (AGENT) |
| Authorized Official Contact | 18005559073 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Georgia Sports Medicine 5050 Spring Valley Rd Dallas TX 75244-3995 Ph: (800) 555-9073 | West Georgia Sports Medicine 1601 Maple St Carrollton GA 30118-0001 Ph: (678) 839-6628 |
| NPI Number | 1235528811 |
|---|---|
| Provider Enumeration Date | 01/20/2015 |
| Last Update Date | 01/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235528811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Secondary |
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