Provider Demographics
NPI:1194793307
Name:WEST GEORGIA INTERNAL MEDICINE PC
Entity type:Organization
Organization Name:WEST GEORGIA INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-834-6208
Mailing Address - Street 1:706 DIXIE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3890
Mailing Address - Country:US
Mailing Address - Phone:770-834-6208
Mailing Address - Fax:770-830-7620
Practice Address - Street 1:706 DIXIE ST STE 300
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3890
Practice Address - Country:US
Practice Address - Phone:770-834-6208
Practice Address - Fax:770-830-7620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85002004GMedicaid
GRP3151Medicare UPIN
GA85002004GMedicaid