Provider Demographics
NPI:1194958421
Name:WEST GEORGIA MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:WEST GEORGIA MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-644-0012
Mailing Address - Street 1:1800 PARKWAY PL SE STE 500
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8237
Mailing Address - Country:US
Mailing Address - Phone:470-956-4981
Mailing Address - Fax:770-999-2489
Practice Address - Street 1:140 GLENN BASS RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-5809
Practice Address - Country:US
Practice Address - Phone:706-845-3282
Practice Address - Fax:706-845-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00409186AMedicaid
112311Medicare Oscar/Certification